Healthcare Provider Details

I. General information

NPI: 1003803990
Provider Name (Legal Business Name): GENERAL OPTICAL COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 S CENTER RD SUITE 16
BURTON MI
48509-1700
US

IV. Provider business mailing address

405 GARLAND ST
DAVISON MI
48423-1330
US

V. Phone/Fax

Practice location:
  • Phone: 810-744-1950
  • Fax: 810-744-1515
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES MOORE
Title or Position: PRESIDENT
Credential:
Phone: 810-744-1950