Basic Information
| Provider Information | |||||||||
| NPI: | 1124370366 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RADEMACHER | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2040 AURELIUS RD | ||||||||
| Address2: | SUITE 20 | ||||||||
| City: | HOLT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488421367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176993937 | ||||||||
| FaxNumber: | 5176994199 | ||||||||
| Practice Location | |||||||||
| Address1: | 2040 AURELIUS RD | ||||||||
| Address2: | SUITE 20 | ||||||||
| City: | HOLT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488421367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176993937 | ||||||||
| FaxNumber: | 5176994199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2012 | ||||||||
| LastUpdateDate: | 10/12/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4901004707 | MI | Y | Eye and Vision Services Providers | Optometrist | 152WC0802X | 4901004707 | MI | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management |
No ID Information.