1821383613 NPI number — EYECARE PROFESSIONALS OF MICHIGAN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821383613 NPI number — EYECARE PROFESSIONALS OF MICHIGAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYECARE PROFESSIONALS OF MICHIGAN
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:
Provider Other Organization Name Type Code:
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:
1821383613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28024 BRIAR HILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48336-2214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-497-9904
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18900 MICHIGAN AVE
Provider Second Line Business Practice Location Address:
SUITE 1001
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48126-3929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-271-0383
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
VOYLES
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
PALMA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
248-497-9904

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4901003309 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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