Individual
MATTHEW BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3901 ALPINE AVE NW, COMSTOCK PARK, MI 49321-8350
(616) 647-2213
Mailing address
3901 ALPINE AVE NW, COMSTOCK PARK, MI 49321-8350
(616) 647-2213
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901005112
MI
Other
Enumeration date
06/20/2018
Last updated
09/08/2020
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