PEDIATRIC OPHTHALMOLOGY PC NPI 1225278880

NPI Information

  • NPI: 1225278880
  • Provider Name: PEDIATRIC OPHTHALMOLOGY PC
  • Classification: Optometrist - 152WP0200X
  • Specialization: Pediatrics
  • Entity Type: Organization
  • Address: 5050 CASCADE RD SE
    GRAND RAPIDS, MI
    ZIP 49546
  • Phone: (616) 957-0866

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NPI Details

PEDIATRIC OPHTHALMOLOGY PC is a pediatrics optometrist in Grand Rapids, MI. The provider is optometrists who work in Pediatrics are concerned with the prevention, development, diagnosis, and treatment of visual problems in children. PEDIATRIC OPHTHALMOLOGY PC NPI is 1225278880. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

5050 CASCADE RD SE
GRAND RAPIDS, MI
ZIP 49546-707
Phone: (616) 957-0866
Fax: (616) 957-4102

The provider's authorized official is Deborah M Droste .
The authorized official title is Administrator and has the following contact phone number (616) 957-0866.

The enumeration date for this NPI number is 2/23/2009 and was last updated on 9/11/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1152WP0200XOptometristPediatrics003979MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12636622MEDICAIDMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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