Provider Demographics
NPI:1700310430
Name:ENVISION EYE CARE PLLC
Entity Type:Organization
Organization Name:ENVISION EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:KREBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-799-2020
Mailing Address - Street 1:5310 HAMPTON PL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-8202
Mailing Address - Country:US
Mailing Address - Phone:989-799-2020
Mailing Address - Fax:989-799-8700
Practice Address - Street 1:5310 HAMPTON PL
Practice Address - Street 2:SUITE 2
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-8202
Practice Address - Country:US
Practice Address - Phone:989-799-2020
Practice Address - Fax:989-799-8700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075068332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6171810001Medicare NSC
MI0P60990Medicare PIN
MIG58395Medicare UPIN