Provider Demographics
NPI:1891755120
Name:VISEL, JAMISON ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:JAMISON
Middle Name:ELIZABETH
Last Name:VISEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JAMISON
Other - Middle Name:ELIZABETH
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:420 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1516
Mailing Address - Country:US
Mailing Address - Phone:810-227-2004
Mailing Address - Fax:810-227-9910
Practice Address - Street 1:420 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1516
Practice Address - Country:US
Practice Address - Phone:810-227-2004
Practice Address - Fax:810-227-9910
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004308152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1891755120Medicaid
H17642020OtherMEDICARE - UNSPECIFIED
JB004308OtherBCBS MICHIGAN
H17642020OtherMEDICARE - UNSPECIFIED