Healthcare Provider Details

I. General information

NPI: 1184252165
Provider Name (Legal Business Name): CAPSTONE VISION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 N SQUIRREL RD STE 202
AUBURN HILLS MI
48326-2871
US

IV. Provider business mailing address

691 N SQUIRREL RD STE 202
AUBURN HILLS MI
48326-2871
US

V. Phone/Fax

Practice location:
  • Phone: 248-710-0063
  • Fax: 240-710-0056
Mailing address:
  • Phone: 248-710-0063
  • Fax: 248-710-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: LESLIE EMMERT-BUCK
Title or Position: CEO
Credential: MD, PHD
Phone: 248-710-0063