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Individual

MRS. MONICA ANNE FENTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
750 E BELTLINE AVE NE, STE 202, GRAND RAPIDS, MI 49525-6049
(616) 949-2600
(616) 365-2076
Mailing address
750 E BELTLINE AVE NE, STE 202, GRAND RAPIDS, MI 49525-6046
(616) 949-2600
(616) 954-0213

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004006
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
410044559
MEDICARE RR
MI
05
4247543
MI
01
900G06541
BCBS
MI
Enumeration date
06/13/2005
Last updated
06/09/2008
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