Healthcare Provider Details

I. General information

NPI: 1477678514
Provider Name (Legal Business Name): FAGELMAN EYEWEAR LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39400 GARFIELD RD 102
CLINTON TOWNSHIP MI
48038-4096
US

IV. Provider business mailing address

39400 GARFIELD RD 102
CLINTON TOWNSHIP MI
48038-4096
US

V. Phone/Fax

Practice location:
  • Phone: 586-286-6550
  • Fax: 586-286-1843
Mailing address:
  • Phone: 586-286-6550
  • Fax: 586-286-1843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. JERRY S FAGELMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 586-286-6550