Provider Demographics
NPI:1801084082
Name:FOREST PLACE OPTICAL
Entity type:Organization
Organization Name:FOREST PLACE OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GETSCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:734-455-3340
Mailing Address - Street 1:449 S HARVEY ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1738
Mailing Address - Country:US
Mailing Address - Phone:734-455-3340
Mailing Address - Fax:734-455-1727
Practice Address - Street 1:449 S HARVEY ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1738
Practice Address - Country:US
Practice Address - Phone:734-455-3340
Practice Address - Fax:734-455-1727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540H204540OtherBCBS
MI540H204540OtherBCBS