Organization
MODERN OPTICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VINCE CONENS (PRESIDENT)
(616) 949-5860
Entity
Organization
Contact information
Practice address
4228 29TH ST SE, GRAND RAPIDS, MI 49512-1936
(616) 949-5860
Mailing address
4228 29TH ST SE, GRAND RAPIDS, MI 49512-1936
(616) 949-5860
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
4901002933
MI
152W00000X
Optometrist
Primary
4901004140
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900D11540-0
BLUE CROSS - EXAMS
MI
Enumeration date
03/20/2007
Last updated
09/18/2009
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