Dr. Maxwell Edward Rennaker, OD
Optometrist in Grand Rapids, MI. Individual provider (NPI-1).
NPI number1366934879
StatusActive
Last updated in NPPESSep 9, 2020
Details
- NPI
- 1366934879
- Entity type
- Individual (NPI-1)
- Name
- Dr. Maxwell Edward Rennaker
- Credential
- OD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 31, 2018
- Certification date
- Sep 9, 2020
- Last updated
- Sep 9, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - OPTOMETRY
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 4901005238 | MI | Yes |
| 152W00000X | Optometrist | OPT.006660 | OH |
Practice location
2700 5 Mile Rd Ne Ste 102Grand Rapids, MI 49525-6516
Phone 330-908-8000
Mailing address
3736 Prairie St SwGrandville, MI 49418-1634
Phone 616-648-8456
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