DAN LEE FORTENBACHER (NPI# 1760519946) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760519946 |
| Entity Type | Individual |
| Full Name | DAN LEE FORTENBACHER |
| Credential | O.D. |
| Practice Address |
2908 Division Street St Joseph MI 49085 |
| Practice Telephone | 2699833309 |
| Practice Fax Number | 2699830846 |
| Mailing Telephone | 2699833309 |
| Mailing Fax Number | 2699830846 |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2015-05-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 152W00000X | Optometrist | 4901002693 | MI | Eye and Vision Services Providers |
| Y | 152WV0400X |
Optometrist Specialization: Vision Therapy |
4901002693 | MI | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BLUE CROSS BLUE SHIELD OF MICHIGAN | 900A165280 | 01 |
| Street Address |
2908 DIVISION STREET |
| City | ST JOSEPH |
| State | MI |
| Zip Code | 49085 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134758949 | Ahmed Elshareif | Student in an Organized Health Care Education/Training Program | Lakeland Health, 1234 Napier Avenue, Saint Joseph, MI 49085 | 2020-04-03 |
| 1033747225 | Ezra Fox | Student in an Organized Health Care Education/Training Program | Lakeland Health- Gme, 1234 Napier Avenue, St. Joseph, MI 49085 | 2020-04-01 |
| 1679033930 | Asad Butt | Student in an Organized Health Care Education/Training Program | Lakeland Health-gme, 1234 Napier Avenue, Saint Joseph, MI 49085 | 2019-03-22 |
| 1184194714 | Benjamin Phillip Knuth | Physical Therapist | 3950 Hollywood Road, Suite 140, Saint Joseph, MI 49085 | 2018-11-27 |
| 1336624279 | Brandi Chatot | Counselor | 1101 Broad Street #8, Saint Joseph, MI 49085 | 2018-09-26 |
| 1396239562 | Lakeland Medical Practices | Family Medicine | 2500 Niles Ave., Suite 1, St. Joseph, MI 49085 | 2018-06-20 |
| 1760976518 | Premier Health Associates, Inc. | Home Health | 1111 Main Sr, St Joseph, MI 49085 | 2018-06-15 |
| 1053817783 | Chantell Strong | Student in an Organized Health Care Education/Training Program | Lakeland Health - Gme, 1234 Napier Avenue, Saint Joseph, MI 49085 | 2018-04-02 |
| 1386144053 | Anjana Gupta, Dds, Pllc | Dentist | 2800 Niles Road, Saint Joseph, MI 49085 | 2018-02-19 |
| 1356858997 | Hope Reborn Counseling, Pllc | Counselor | 2816 Willa Dr, Saint Joseph, MI 49085 | 2018-01-04 |
| Find all providers in zip 49085 | ||||
| Taxonomy Code | 152WV0400X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Specialization | Vision Therapy |
| Optometrists who specialize in vision therapy as a treatment process used to improve vision function. It includes a broad range of developmental and rehabilitative treatment programs individually prescribed to remediate specific sensory, motor and/or visual perceptual dysfunctions. |
| Notes: Source: American Optometric Association [1/1/2009: added definition, added source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427585801 | Frye's New Look Optical | Optometrist | 12897 Woodward Ave, Highland Park, MI 48203-3315 | 2017-05-17 |
| 1548628415 | Academy of Vision Development, Pllc | Optometrist | 6617 Crossings Dr Se, Suite 102, Grand Rapids, MI 49508-7378 | 2016-02-05 |
| 1548675242 | Davich Midwest Inc | Optometrist | 2825 28th St Se, Grand Rapids, MI 49512-1607 | 2014-06-22 |
| 1063844108 | Tuan Tran | Optometrist | 19700 14 Mile Rd, C306, Big Rapids, MI 49307-8757 | 2013-07-31 |
| 1932300928 | Vision Associates of Westland | Optometrist | 38979 Cherry Hill Rd., Suite B, Westland, MI 48186 | 2007-05-29 |
| 1437212560 | John Paul Jacobi | Optometrist | 32415 5 Mile Rd, Livonia, MI 48154-3039 | 2006-12-19 |
| 1174590285 | Randy Gerard Houdek | Optometrist | 38979 Cherry Hill Rd, Suite B, Westland, MI 48186-3250 | 2006-03-07 |
| 1285293738 | G Stephanie Enriquez Od Pllc | Optometrist | 4091 Richfield Rd, Flint, MI 48506-2033 | 2019-06-09 |
| 1801383260 | Vision Therapy Institute of Mi, LLC | Optometrist | 330 W Lake Lansing Rd, East Lansing, MI 48823-8527 | 2018-04-20 |
| 1891247813 | Gr Davich Inc | Optometrist | 2825 28th St Se, Suite B, Grand Rapids, MI 49512-1607 | 2016-10-25 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.