Healthcare Provider Details

I. General information

NPI: 1205863727
Provider Name (Legal Business Name): OPTOMETRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42550 GARFIELD RD SUITE 101
CLINTON TWP MI
48038-1644
US

IV. Provider business mailing address

42550 GARFIELD RD SUITE 101
CLINTON TWP MI
48038-1644
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-9708
  • Fax: 586-263-0280
Mailing address:
  • Phone: 586-263-9708
  • Fax: 586-263-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD WILLIAM LAKIN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 586-263-9708