Organization
MICHIGAN STREET OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD H BENNINGER MD (OWNER)
(269) 373-8878
Entity
Organization
Contact information
Practice address
426 MICHIGAN ST NE, SUITE 101, GRAND RAPIDS, MI 49503-5609
(616) 459-1844
(616) 459-3716
Mailing address
PO BOX 2588, PORTAGE, MI 49081-2588
(269) 373-8878
(269) 373-4720
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
4301030073
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
540D116620
BLUE CROSS BLUE SHEILD
MI
Enumeration date
02/06/2007
Last updated
07/29/2008
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