Provider Demographics
NPI:1487691366
Name:WEST MICHIGAN EYECARE ASSOCIATES LLC
Entity type:Organization
Organization Name:WEST MICHIGAN EYECARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-949-8500
Mailing Address - Street 1:2112 EAST PARIS AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-949-8500
Mailing Address - Fax:616-949-2878
Practice Address - Street 1:2112 EAST PARIS AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-949-8500
Practice Address - Fax:616-949-2878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900D11106OtherBCBSM
MI0M67910Medicare PIN
MI0557910001Medicare NSC