Organization
PORTAGE FAMILY VISION CARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEANNA LYN MAYO OD (OD/OWNER)
(269) 324-4242
Entity
Organization
Contact information
Practice address
6483 S. WESTNEDGE AVE., PORTAGE, MI 49002-3542
(269) 324-4242
(269) 324-6145
Mailing address
6483 S. WESTNEDGE AVE., PORTAGE, MI 49002-3542
(269) 324-4242
(269) 324-6145
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004152
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4929042
—
MI
Enumeration date
10/28/2010
Last updated
10/28/2010
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