MEDICARE: EAGLE EYE COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service	6801034348	MI

General Provider Information

NPI Number	:	1235434614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE EYE COUNSELING PLLC

Provider Business Mailing Address
First Line	:	20836 HALL RD
Second Line	:	SUITE 184
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-7227
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	37565 CHARTER OAKS BLVD
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48036-4437
Country	:	US
Telephone Number	:	586-783-7153
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MS. PHYLLIS WALKER
Credential	:
Telephone Number	:	586-783-7153

Provider Enumeration Date	:	01/17/2011
Last Update Date	:	07/23/2015

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