Provider Demographics
NPI:1841281037
Name:PRINCE, STEPHEN MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:PRINCE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 E BROOMFIELD RD
Mailing Address - Street 2:STE 6
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9502
Mailing Address - Country:US
Mailing Address - Phone:989-773-2020
Mailing Address - Fax:
Practice Address - Street 1:1230 E BROOMFIELD RD
Practice Address - Street 2:STE 6
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-9502
Practice Address - Country:US
Practice Address - Phone:989-773-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002709152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
900C765050OtherBCBS
900C765050OtherBCBS
U37067Medicare UPIN