Provider Demographics
NPI:1740361427
Name:KARI VISSER-ROBEL OD PC
Entity type:Organization
Organization Name:KARI VISSER-ROBEL OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:MARTHA
Authorized Official - Last Name:VISSER-ROBEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:989-705-1255
Mailing Address - Street 1:PO BOX 1220
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49734-5220
Mailing Address - Country:US
Mailing Address - Phone:989-705-1255
Mailing Address - Fax:989-705-1476
Practice Address - Street 1:713 S WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1766
Practice Address - Country:US
Practice Address - Phone:989-705-1255
Practice Address - Fax:989-705-1476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI410047657OtherMEDICARE RR
MI0P39250Medicare PIN
MIU58039Medicare UPIN
MI5780140001Medicare NSC