Individual
DR. LARA ANN EENIGENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
103 S DIVISION AVE, PO BOX E, FREMONT, MI 49412-1602
(231) 924-4110
(231) 924-5007
Mailing address
103 S DIVISION AVE, PO BOX E, FREMONT, MI 49412-1602
(231) 924-4110
(231) 924-5007
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004195
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410014405
MEDICARE RAILROAD
MI
05
—
4640938
—
MI
01
—
4901004195
LICENSE NUMBER
MI
01
—
900F210120
BC BS OF MI
MI
Enumeration date
07/13/2005
Last updated
05/21/2008
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