OCULOPLASTIC ASSOCIATES OF WEST MICHIGAN, PLC (NPI# 1174974356) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174974356 |
| Entity Type | Organization |
| Organization Name | OCULOPLASTIC ASSOCIATES OF WEST MICHIGAN, PLC |
| Practice Address |
4070 Lake Dr Se Suite 205 Grand Rapids MI 49546-8294 |
| Practice Telephone | 6168882948 |
| Practice Fax Number | 6168882949 |
| Mailing Telephone | 6168882948 |
| Mailing Fax Number | 6168882949 |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2016-10-05 |
| Authorized Official Name | TIFFANY L KENT (OWNER, PHYSICIAN) |
| Authorized Official Telephone | 6168882948 |
| Authorized Official Credential | MD, PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207WX0200X |
Ophthalmology Specialization: Ophthalmic Plastic and Reconstructive Surgery |
4301092933 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NPI | 1164686812 | 01 |
| Street Address |
4070 LAKE DR SE SUITE 205 |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49546-8294 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629054127 | Michael T Vollink | Optometrist | 4070 Lake Dr Se, Suite 101, Grand Rapids, MI 49546-8294 | 2005-12-16 |
| 1417365339 | Cynthia Geneva | Optometrist | 4070 Lake Dr Se, Suite 101, Grand Rapids, MI 49546-8294 | 2014-07-23 |
| 1376771717 | Advanced Urology of Grand Rapids | Urology | 4070 Lake Dr Se, Suite L101, Grand Rapids, MI 49546-8294 | 2009-06-24 |
| 1609018233 | Mark S Obrien Md Plc | Internal Medicine | 4070 Lake Dr Se, Suite 201, Grand Rapids, MI 49546-8294 | 2009-03-27 |
| 1164686812 | Tiffany Lauren Kent | Ophthalmology | 4070 Lake Dr Se, Suite 205, Grand Rapids, MI 49546-8294 | 2008-07-11 |
| 1295995629 | Physical Therapy Services of Grand Rapids, LLC | Clinic/Center | 4070 Lake Dr Se, Suite: 204, Grand Rapids, MI 49546-8294 | 2008-06-10 |
| 1528254877 | Nephrology Consultants of Grand Rapids PC | Internal Medicine | 4070 Lake Dr Se, Suite 201, Grand Rapids, MI 49525 | 2007-09-20 |
| 1457462467 | Richard Phillip Oconnor Jr. | Internal Medicine | 4070 Lake Dr Se, Ste 201, Grand Rapids, MI 49546-8294 | 2006-08-31 |
| 1972612919 | David E Thompson | Urology | 4070 Lake Dr Se, Ste 103, Grand Rapids, MI 49546-8294 | 2006-08-30 |
| 1356450290 | Michael Edward Novak | Urology | 4070 Lake Dr Se, Grand Rapids, MI 49546-8294 | 2006-08-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437762986 | Amanda Mae Ostrom | Speech-Language Pathologist | 710 Kenmore Ave Se, #110, Grand Rapids, MI 49546 | 2020-08-25 |
| 1063075562 | Kelly Lynn Ibarra | Counselor | 4467 Cascade Road Se, Suite #4479, Grand Rapids, MI 49546 | 2019-04-19 |
| 1891257036 | Jessica Matthews LLC | Counselor | 4127 Embassy Drive Se, Grand Rapids, MI 49546 | 2019-04-05 |
| 1326518531 | Neah Morgan | Technician | 4220 Burton St Se, Grand Rapids, MI 49546 | 2018-11-29 |
| 1316430267 | Michael John Benskey | Case Manager/Care Coordinator | 4065 Saladin St Se, Grand Rapids, MI 49546 | 2018-06-14 |
| 1679062772 | Smile Cascade, P.C. | Clinic/Center | 4505 Cascade Rd Se # A, Grand Rapids, MI 49546 | 2018-05-03 |
| 1720583289 | Jeromy Krogman | Counselor | 826 Parchment Drive Se, Grand Rapids, MI 49546 | 2018-03-27 |
| 1841792660 | Affordable Hearing Clinic | Hearing Instrument Specialist | 833 Kenmoor Ave Se Ste G, Grand Rapids, MI 49546 | 2018-03-07 |
| 1689176133 | Kelly Pines | Physical Therapist | 625 Kenmoor Ave Suite 306, Grand Rapids, MI 49546 | 2018-03-01 |
| 1467971440 | Deanna Elizabeth Saenz | Social Worker | 2100 Raybrook St Se Ste 300, Grand Rapids, MI 49546 | 2017-09-12 |
| Find all providers in zip 49546 | ||||
| Taxonomy Code | 207WX0200X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| Specialization | Ophthalmic Plastic and Reconstructive Surgery |
| A physician who specializes in oculofacial plastic and reconstructive surgery. This subspecialty combines orbital and periocular surgery with facial plastic surgery, and includes aesthetic and reconstructive surgery of the face, orbit, eyelid, and lacrimal system. Practitioners evaluate, diagnose and treat conditions involving the eyelids, brows, midface, orbits, lacrimal systems and surrounding and supporting structures of the face and neck. |
| Notes: Source: American Academy of Ophthalmology, 2015. www.aao.org [1/1/2016: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750700746 | Robert Allan Beaulieu | Ophthalmology | 29201 Telegraph Rd Ste 324, Southfield, MI 48034-7646 | 2014-04-07 |
| City | GRAND RAPIDS |
| Zip Code | 49546 |
Please comment or provide details below to improve the information on OCULOPLASTIC ASSOCIATES OF WEST MICHIGAN, PLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.