Individual
DR. LEON JAMES BANGMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2897 RADCLIFF AVE SE, KENTWOOD, MI 49512-1793
(616) 942-2710
(616) 942-8680
Mailing address
105 W EXCHANGE ST, SPRING LAKE, MI 49456-2024
(616) 846-0620
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002511
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4450521
—
MI
05
—
5175734
—
MI
Enumeration date
04/06/2006
Last updated
10/29/2007
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