Provider Demographics
NPI:1730163890
Name:MCDOWELL, JEROME LINN (OD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:LINN
Last Name:MCDOWELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 W SAVIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1607
Mailing Address - Country:US
Mailing Address - Phone:616-844-7000
Mailing Address - Fax:616-844-7444
Practice Address - Street 1:314 W SAVIDGE ST
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-1607
Practice Address - Country:US
Practice Address - Phone:616-844-7000
Practice Address - Fax:616-844-7444
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002359152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4616567Medicaid
MI0N88020Medicare ID - Type UnspecifiedMEDICARE MICHIGAN GROUP
MI4080110001Medicare NSC
MIN88020007Medicare ID - Type UnspecifiedMI MEDICARE INDIVIDUAL
MI4616567Medicaid