1346414380 NPI number — MILLMAN-DERR OPTICAL MACOMB, LTD.

Table of content: (NPI 1346414380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346414380 NPI number — MILLMAN-DERR OPTICAL MACOMB, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLMAN-DERR OPTICAL MACOMB, LTD.
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:
1346414380
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
375 BARCLAY CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48307-4511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-852-3636
Provider Business Mailing Address Fax Number:
248-852-3631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17900 23 MILE RD
Provider Second Line Business Practice Location Address:
SUITE #100
Provider Business Practice Location Address City Name:
MACOMB
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-416-1544
Provider Business Practice Location Address Fax Number:
586-416-1520
Provider Enumeration Date:
04/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DERR
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
NELSON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-852-3636

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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