Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 4901004219 | MI |
Y | 152WP0200X | Pediatric Optomitrist | 4901004219 | MI |
N | 152WV0400X | Optomitrist - Vision Therapist | 4901004219 | MI |
NPI | 1033159348 |
---|---|
Provider Name | Dr. Kiersten Coon |
First Address | Grand Rapids, MI 49503-2802 |
Second Address | Grand Rapids, MI 49503-2802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 25/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4599036 | (05) | MI |
5474550001 | ADMINASTAR SUPPLY # (01) | MI |
900D114840 | BCBS PIN NUMBER (01) | MI |
U92856 | (02) | MI |