Bassima Mowaffak Al-Delaigan
Individual provider Active NPI Optometrist · Big Rapids, MI
NPI 1083847321 · NPPES record last updated Sep 3, 2009
Key facts
- NPI
- 1083847321
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 4901004547 (MI)
- Practice address
- 1310 Cramer Cir
Pennock 502
Big Rapids, MI 49307-2736 - Phone
- (231) 591-2222
- NPI assigned
- Sep 3, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901004547 | MI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ferris State University | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901004547 | MI | Yes |
Addresses
Primary practice location
1310 Cramer Cir
Pennock 502
Big Rapids, MI 49307-2736
Mailing address
1310 Cramer Cir
Pennock 502
Big Rapids, MI 49307-2736
Phone (231) 591-2222
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0784610001 | Other | ADMINASTAR | |
| 999998001 | Other | VSP | |
| 900006367 | Other | PRIORITY HEALTH | |
| 900E47602 | Other | BLUE CROSS MEDICAL |
Other providers in Big Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 3, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.