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Individual

DR. LISA MARIE SLADEK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
55 CAMPAU AVE NW, SUITE 10, GRAND RAPIDS, MI 49503-2642
(616) 459-7380
(616) 459-5752
Mailing address
55 CAMPAU AVE NW, SUITE 10, GRAND RAPIDS, MI 49503-2642
(616) 459-7380
(616) 459-5752

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003881
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
900D114630
BLUE CROSS BLUE SHIELD
MI
Enumeration date
02/26/2007
Last updated
02/11/2010
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