Provider Demographics
NPI:1902839681
Name:SIGHT EYE CLINIC, PC
Entity Type:Organization
Organization Name:SIGHT EYE CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEUSCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-396-5235
Mailing Address - Street 1:2025 VAN HILL DR
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-6904
Mailing Address - Country:US
Mailing Address - Phone:616-396-5235
Mailing Address - Fax:616-396-5380
Practice Address - Street 1:2025 VAN HILL DR
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-6904
Practice Address - Country:US
Practice Address - Phone:616-396-5235
Practice Address - Fax:616-396-5380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104736618Medicaid
MIDD025983OtherBCBSM
MIEL075059OtherBCBSM
MI0G01021OtherBCBSM
MI103469725Medicaid
MIBH078193OtherBCBSM
MI104133598Medicaid
MIH04326Medicare UPIN
MIBH078193OtherBCBSM
MIB46496Medicare UPIN
MIDD025983OtherBCBSM
MIEL075059OtherBCBSM