Provider Demographics
NPI:1104095165
Name:DANIEL A ARSULOWICZ O.D.
Entity type:Organization
Organization Name:DANIEL A ARSULOWICZ O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARSULOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-453-8223
Mailing Address - Street 1:3935 LAKE MICHIGAN DR NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-7844
Mailing Address - Country:US
Mailing Address - Phone:616-453-8223
Mailing Address - Fax:616-453-6262
Practice Address - Street 1:3935 LAKE MICHIGAN DR NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-7844
Practice Address - Country:US
Practice Address - Phone:616-453-8223
Practice Address - Fax:616-453-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002358332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0772830001Medicare NSC