Healthcare Provider Details

I. General information

NPI: 1457439416
Provider Name (Legal Business Name): DESIGN 309 LLC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7609 BROCKWAY RD
BROCKWAY MI
48097-3459
US

IV. Provider business mailing address

7609 BROCKWAY RD
BROCKWAY MI
48097-3459
US

V. Phone/Fax

Practice location:
  • Phone: 810-387-9333
  • Fax: 810-387-9020
Mailing address:
  • Phone: 810-387-9333
  • Fax: 810-387-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CATHERINE ANNE BEDY
Title or Position: GENERAL MANAGER
Credential:
Phone: 810-387-9333