Provider Demographics
NPI:1972695617
Name:HUDSONVILLE VISION CARE INC
Entity type:Organization
Organization Name:HUDSONVILLE VISION CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WUSTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-669-2530
Mailing Address - Street 1:3232 CENTRAL BLVD
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-1439
Mailing Address - Country:US
Mailing Address - Phone:616-669-2530
Mailing Address - Fax:616-669-3646
Practice Address - Street 1:3232 CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-1439
Practice Address - Country:US
Practice Address - Phone:616-669-2530
Practice Address - Fax:616-669-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI942704876Medicaid
MI942708884Medicaid
MI942708884Medicaid
MI0883760001Medicare NSC
MIDD8875Medicare PIN