Healthcare Provider Details

I. General information

NPI: 1750391603
Provider Name (Legal Business Name): MARIE E. PITKO OPTICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42524 HAYES RD STE 300
CLINTON TWP MI
48038-3643
US

IV. Provider business mailing address

42524 HAYES STE. #300
CLINTON TWP. MI
48038
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-9740
  • Fax: 586-228-1507
Mailing address:
  • Phone: 586-228-9740
  • Fax: 586-286-1507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: