Basic Information
| Provider Information | |||||||||
| NPI: | 1992795132 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VONSEGGERN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 W EXCHANGE ST | ||||||||
| Address2: | |||||||||
| City: | SPRING LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494562024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168460620 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 101 S LAFAYETTE ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488381933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6167546300 | ||||||||
| FaxNumber: | 6167545009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2005 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 18004210A | IN | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 4901003781 | MI | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 201249427 | 01 | MI | TAX ID | OTHER | 900G011510 | 01 | MI | BCBS OF MICHIGAN | OTHER | P55978 | 01 | MI | BCN | OTHER | 230541 | 01 | MI | NVA | OTHER | 900F111210 | 01 | MI | BCBS OF MICHIGAN | OTHER | 202916337 | 01 | MI | TAX ID | OTHER | 4634180 | 05 | MI | MEDICAID |