Individual
DR. LORNE M GOTTESMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
220 S MAIN ST, ROCHESTER, MI 48307-2029
(248) 858-2223
Mailing address
220 S MAIN ST, ROCHESTER, MI 48307-2029
(248) 651-7986
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004008
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F37720
MEDICARE PTAN
—
05
—
1811975402
—
MI
05
—
4148376
—
MI
05
—
4148394
—
MI
01
—
LG004008
BLUE CROSS
MI
Enumeration date
01/04/2006
Last updated
05/16/2016
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