Provider Demographics
NPI:1831434174
Name:OPTICS PLUS LLC
Entity type:Organization
Organization Name:OPTICS PLUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER/OPTICIAN
Authorized Official - Phone:231-744-0440
Mailing Address - Street 1:1343 WHITEHALL ROAD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445
Mailing Address - Country:US
Mailing Address - Phone:231-744-0440
Mailing Address - Fax:231-719-0291
Practice Address - Street 1:1343 WHITEHALL ROAD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445
Practice Address - Country:US
Practice Address - Phone:231-744-0440
Practice Address - Fax:231-719-0291
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTICS PLUS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI864556948Medicaid
MI944556039Medicaid