MEDICARE: CLIO VISION SERVICES INC

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	4901002607	MI

General Provider Information

NPI Number	:	1952432361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLIO VISION SERVICES INC

Provider Business Mailing Address
First Line	:	2155 W VIENNA RD
Second Line	:
City	:	CLIO
State	:	MI
Zip	:	48420-1261
Country	:	US
Telephone Number	:	810-686-8372
Fax Number	:	810-686-1682

Provider Business Practice Location Address
First Line	:	2155 W VIENNA RD
Second Line	:
City	:	CLIO
State	:	MI
Zip	:	48420-1757
Country	:	US
Telephone Number	:	810-686-4240
Fax Number	:	810-686-1682

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARTIN QUILLEN
Credential	:
Telephone Number	:	810-686-8372

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	04/02/2008

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Directions to “CLIO VISION SERVICES INC ” Practice Location

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