Individual
JOHN JAMES BUSHAW IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
800 S ADAMS RD STE 201, BIRMINGHAM, MI 48009-7008
(248) 644-8060
Mailing address
800 S ADAMS RD STE 201, BIRMINGHAM, MI 48009-7008
(248) 644-8060
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901005131
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/27/2018
Last updated
09/20/2019
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