Healthcare Provider Details

I. General information

NPI: 1619084712
Provider Name (Legal Business Name): LORRAINE BYERS-MILLER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8470 MAIN ST
BIRCH RUN MI
48415-9461
US

IV. Provider business mailing address

8470 MAIN ST
BIRCH RUN MI
48415-9461
US

V. Phone/Fax

Practice location:
  • Phone: 989-624-2020
  • Fax:
Mailing address:
  • Phone: 989-624-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004311
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: