MEDICARE: FRENCHTOWN OPTICAL PLC

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	152W00000X	Optometrist	4901003268	MI

General Provider Information

NPI Number	:	1477753754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRENCHTOWN OPTICAL PLC

Provider Business Mailing Address
First Line	:	7505 GRAFTON RD
Second Line	:	SUITE 3
City	:	NEWPORT
State	:	MI
Zip	:	48166-8908
Country	:	US
Telephone Number	:	734-586-2000
Fax Number	:	734-586-2008

Provider Business Practice Location Address
First Line	:	7505 GRAFTON RD
Second Line	:	SUITE 3
City	:	NEWPORT
State	:	MI
Zip	:	48166-8908
Country	:	US
Telephone Number	:	734-586-2000
Fax Number	:	734-586-2008

Authorized Official
Title or Position	:	SOLE MBR
Name	:	DR. GLENN MARK YOUNG
Credential	:	O.D.
Telephone Number	:	734-242-4123

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	07/24/2007

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Directions to “FRENCHTOWN OPTICAL PLC ” Practice Location

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