Organization
FAMILY & PEDIATRIC EYE CARE PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GENE ERNEST FONGER OD (STORE OWNER)
(616) 459-0641
Entity
Organization
Contact information
Practice address
144 MONROE CENTER, GRAND RAPIDS, MI 49503-2802
(616) 459-0641
(616) 459-0621
Mailing address
144 MONROE CTR NW, GRAND RAPIDS, MI 49503-2802
(616) 459-0641
(616) 459-0621
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
4901002505
MI
152WP0200X
Pediatric Optometrist
Primary
4901004219
MI
152WV0400X
Vision Therapy Optometrist
4901004219
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0P19680
MEDICARE GROUP NUMBER
MI
05
—
4599036
—
MI
05
—
5041964
—
MI
01
—
900D114840
BCBS PIN #
MI
01
—
900D114850
BCBS PIN #
MI
01
—
T33048
UPIN
MI
01
—
U92856
UPIN
MI
Enumeration date
11/12/2007
Last updated
06/30/2016
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