Basic Information
| Provider Information | |||||||||
| NPI: | 1235230350 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAPIDS OPHTHALMOLOGY, P.C. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CREW EYE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 LINDEN ST | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | BIG RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493071880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317960010 | ||||||||
| FaxNumber: | 2317962496 | ||||||||
| Practice Location | |||||||||
| Address1: | 650 LINDEN ST | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | BIG RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317960010 | ||||||||
| FaxNumber: | 2317962496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 07/19/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BUTLER | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | JEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2317960010 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | COE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 207W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 0E40038 | 01 | MI | BCBSM - OPTOMETRISTS | OTHER | 180036284 | 01 | MI | MEDICARE RAILROAD | OTHER | CG0293 | 01 | MI | MEDICARE RAILROAD | OTHER | 1280290002 | 01 | MI | MEDICARE NSC - HOWARD CITY | OTHER | 0E41065 | 01 | MI | BCBSM - OPHTHALMOLOGISTS | OTHER | 1235230350 | 01 | MI | COMMERCIAL INSURERS | OTHER |