MEDICARE: UNIQUELY SPECIAL OPTICAL LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	156FX1202X	Optometric Technician
2	156FX1800X	Optician
3	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1629886270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIQUELY SPECIAL OPTICAL LLC

Provider Business Mailing Address
First Line	:	24554 GROVE AVE
Second Line	:
City	:	EASTPOINTE
State	:	MI
Zip	:	48021-1031
Country	:	US
Telephone Number	:	248-818-6702
Fax Number	:

Provider Business Practice Location Address
First Line	:	15370 GRAND RIVER AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48227-2215
Country	:	US
Telephone Number	:	248-818-6702
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. MONIQUE BROWN
Credential	:
Telephone Number	:	248-818-6702

Provider Enumeration Date	:	12/27/2024
Last Update Date	:	01/08/2025

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Directions to “UNIQUELY SPECIAL OPTICAL LLC ” Practice Location

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