Provider Demographics
NPI:1982762241
Name:ARSULOWICZ, DANIEL ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ANTHONY
Last Name:ARSULOWICZ
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 1:3935 LAKE MICHIGAN DR NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-7844
Mailing Address - Country:US
Mailing Address - Phone:616-453-8223
Mailing Address - Fax:
Practice Address - Street 1:3935 LAKE MICHIGAN DR NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-7844
Practice Address - Country:US
Practice Address - Phone:616-453-8223
Practice Address - Fax:616-453-6262
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002358152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900D16546OtherBLUE CROSS BLUE SHIELD
MIT33040Medicare UPIN
MIOD16546Medicare PIN
MI900D16546OtherBLUE CROSS BLUE SHIELD