Provider Demographics
NPI:1720110422
Name:STITES EYE CARE PC
Entity type:Organization
Organization Name:STITES EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:L
Authorized Official - Last Name:STITES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-863-2020
Mailing Address - Street 1:6840 NORTHWAY DR NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-7568
Mailing Address - Country:US
Mailing Address - Phone:616-863-2020
Mailing Address - Fax:616-863-2022
Practice Address - Street 1:6840 NORTHWAY DR NE
Practice Address - Street 2:SUITE A
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7568
Practice Address - Country:US
Practice Address - Phone:616-863-2020
Practice Address - Fax:616-863-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI696719152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5847760001Medicare NSC
MIU46230Medicare UPIN
MI0N96080Medicare PIN