Organization
JEFFREY B. BYLAND, O.D., P.C.
Active
Other names
EXCELLENCE IN VISION
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARA A EENIGENBURG OD (PRESIDENT)
(231) 924-4110
Entity
Organization
Contact information
Practice address
103 S DIVISION AVE, FREMONT, MI 49412-1602
(231) 924-4110
(231) 924-5007
Mailing address
103 S DIVISION AVE, FREMONT, MI 49412-1602
(231) 924-4110
(231) 924-5007
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
4901002849
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2892598
—
MI
01
—
410014405
MEDICARE RAILROAD
MI
01
—
900F26506
BC BS OF MI
MI
Enumeration date
10/18/2006
Last updated
12/06/2020
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