Organization
SOUTH HAVEN EYECARE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALICE M BACAK O.D. (GENERAL PARTNER)
(269) 637-1442
Entity
Organization
Contact information
Practice address
1088 S BAILEY AVE, SUITE B, SOUTH HAVEN, MI 49090-6723
(269) 637-1442
(269) 637-3801
Mailing address
1088 BAILEY AVE, SUITE B, SOUTH HAVEN, MI 49090-6723
(269) 637-1442
(269) 637-3801
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
490100
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H07612
BLUE CROSS BLUE SHIELD
MI
Enumeration date
03/06/2007
Last updated
11/01/2010
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