Organization
CEDAR RUN EYE CENTER
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
3830 W FRONT ST, TRAVERSE CITY, MI 49684-8153
(231) 929-3888
(231) 929-4365
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3166469
—
MI
05
—
3166478
—
MI
05
—
4976991
—
MI
05
—
4977003
—
MI
01
—
900B86347
BCBS
MI
Enumeration date
05/01/2007
Last updated
08/22/2020
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