Healthcare Provider Details

I. General information

NPI: 1972153666
Provider Name (Legal Business Name): SVS VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15620 HALL RD
CLINTON TOWNSHIP MI
48038-1036
US

IV. Provider business mailing address

118 CASS AVE
MOUNT CLEMENS MI
48043-2204
US

V. Phone/Fax

Practice location:
  • Phone: 586-676-9000
  • Fax: 586-408-6038
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT GUY FARRELL
Title or Position: OWNER
Credential: OD
Phone: 586-468-7370