Organization
KALAMAZOO OPTOMETRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACY HIEMSTRA (OFFICE MANAGER)
(269) 382-6500
Entity
Organization
Contact information
Practice address
5949 LOVERS LN, PORTAGE, MI 49002-1680
(269) 382-6500
(269) 382-2286
Mailing address
5949 LOVERS LN, PORTAGE, MI 49002-1680
(269) 382-6500
(269) 382-2286
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002237
MI
152W00000X
Optometrist
4901002352
MI
152W00000X
Optometrist
4901002440
MI
152W00000X
Optometrist
4901004197
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900C947460
BLUE CROSS BLUE SHIELD
MI
05
—
944536386
—
MI
05
—
945006007
—
MI
05
—
945006016
—
MI
05
—
945031190
—
MI
Enumeration date
08/05/2007
Last updated
05/29/2024
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