Provider Demographics
NPI:1215234026
Name:MERIDIAN EYECARE VISION & LEARNING CENTER
Entity type:Organization
Organization Name:MERIDIAN EYECARE VISION & LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORSLINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-449-6677
Mailing Address - Street 1:1669 HAMILTON RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1956
Mailing Address - Country:US
Mailing Address - Phone:517-449-6677
Mailing Address - Fax:517-349-0096
Practice Address - Street 1:1669 HAMILTON RD
Practice Address - Street 2:SUITE 270
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1956
Practice Address - Country:US
Practice Address - Phone:517-449-6677
Practice Address - Fax:517-349-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004143152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty