1316900608 NPI number — P L INC.

Table of content: (NPI 1316900608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316900608 NPI number — P L INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
P L INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
D.O.C CHESTERFIELD VILLAGE SQUARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316900608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27903 23 MILE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTERFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48051-2328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-598-3935
Provider Business Mailing Address Fax Number:
586-598-3941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27903 23 MILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48051-2328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-598-3935
Provider Business Practice Location Address Fax Number:
586-598-3941
Provider Enumeration Date:
04/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
BRYAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
586-598-3935

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4901003653 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 152W00000X , with the licence number: 4901003352 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02262 . This is a "SPECTERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 230850 . This is a "NATIONAL VISION ADMINISTR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11985 . This is a "AVESIS" identifier . This identifiers is of the category "OTHER".




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