Individual
DR. KEVIN MICHAEL BOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
100 CHERRY ST SE, OPTOMETRY CLINIC, GRAND RAPIDS, MI 49503-4526
(616) 965-8200
Mailing address
2257 KINNROW AVE NW, WALKER, MI 49534-1281
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004784
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4901004784
BOARD OF OPTOMETRY
MI
Enumeration date
07/24/2013
Last updated
07/24/2013
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