Organization
CEDAR RUN EYE CENTER OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER GROCHOWALSKI (ADMINISTRATION)
(231) 929-3888
Entity
Organization
Contact information
Practice address
3830 W FRONT ST, TRAVERSE CITY, MI 49684-8153
(231) 929-3888
(231) 929-4365
Mailing address
PO BOX 2335, TRAVERSE CITY, MI 49685-2335
(231) 929-3888
(231) 929-4365
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180B86357
BCBSM
MI
01
—
900B863470
BCBSM
MI
Enumeration date
04/30/2007
Last updated
11/30/2009
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