Provider Demographics
NPI:1750407177
Name:HOMER VISION CENTER INC.
Entity type:Organization
Organization Name:HOMER VISION CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:STETLER
Authorized Official - Suffix:
Authorized Official - Credentials:OPT
Authorized Official - Phone:517-568-4411
Mailing Address - Street 1:125 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:MI
Mailing Address - Zip Code:49245-1023
Mailing Address - Country:US
Mailing Address - Phone:517-568-4411
Mailing Address - Fax:517-568-3526
Practice Address - Street 1:125 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:MI
Practice Address - Zip Code:49245-1023
Practice Address - Country:US
Practice Address - Phone:517-568-4411
Practice Address - Fax:517-568-3526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI52517Medicaid
MI2220046OtherPHYSICIANS HEALTH PLAN
MIA37613003Medicare PIN
MI1152270001Medicare NSC