Individual
PATRICK J EBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2001 COOLIDGE RD, EAST LANSING, MI 48823-1378
(517) 337-1668
(517) 337-1779
Mailing address
1005 CHARLEVOIX DR STE 100, GRAND LEDGE, MI 48837-8186
(517) 337-0316
(517) 622-1205
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003247
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200000001919
PHPMM
MI
05
—
2859332
—
MI
01
—
410033515
RAILROAD MEDICARE
MI
01
—
PE003247
STATE LICENSE NUMBER
MI
Enumeration date
11/29/2005
Last updated
09/20/2022
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