Fortenbacher, Dan Lee
Fortenbacher, Dan Lee is an sole proprietor health care provider with primary practice located at 2908 Division Street , St Joseph MI 49085. He recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Vision Therapy. Eye and Vision Services Providers / Vision Therapy is his primary health care specialty. Fortenbacher, Dan Lee can be contacted via phone (269) 983-3309.Contact Information
Primary practice address
2908 Division Street
St Joseph MI 49085
Phone: (269) 983-3309
Fax: (269) 983-0846
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 4901002693 | Michigan |
| Eye and Vision Services Providers / Vision Therapy | 152WV0400X | 4901002693 | Michigan |
Profile Details
| NPI number | 1760519946 |
|---|---|
| LBN Legal business name | Fortenbacher, Dan Lee |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 27th, 2007 |
| Last updated | May 20th, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1760519946 | NPPES |
| Michigan | Other | 900A165280 | BLUE CROSS BLUE SHIELD OF MICHIGAN |
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