Provider Demographics
NPI:1902895295
Name:ESTES, SAMUEL S (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:S
Last Name:ESTES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2117 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3231
Mailing Address - Country:US
Mailing Address - Phone:517-485-2213
Mailing Address - Fax:517-485-2220
Practice Address - Street 1:2117 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3231
Practice Address - Country:US
Practice Address - Phone:517-485-2213
Practice Address - Fax:517-485-2220
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISE003722152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI943120432Medicaid
MI900C36631OtherBCBS OF MICHIGAN
MI943120432Medicaid
MIU53723Medicare UPIN