MEDICARE: SHORE OPTICAL

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

General Provider Information

NPI Number	:	1669535076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHORE OPTICAL

Provider Business Mailing Address
First Line	:	31503 HARPER AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48082-2455
Country	:	US
Telephone Number	:	586-294-3080
Fax Number	:	586-294-8979

Provider Business Practice Location Address
First Line	:	31503 HARPER AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48082-2455
Country	:	US
Telephone Number	:	586-294-3080
Fax Number	:	586-294-8979

Authorized Official
Title or Position	:	OWNER
Name	:	NIKOLE MURPHY
Credential	:
Telephone Number	:	586-294-3080

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	08/22/2020

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Directions to “SHORE OPTICAL ” Practice Location

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