Healthcare Provider Details

I. General information

NPI: 1992133169
Provider Name (Legal Business Name): GROUP VISION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4337 MAPLE ST
DEARBORN MI
48126-3535
US

IV. Provider business mailing address

4337 MAPLE ST
DEARBORN MI
48126-3535
US

V. Phone/Fax

Practice location:
  • Phone: 313-582-8080
  • Fax: 313-582-8090
Mailing address:
  • Phone: 313-582-8080
  • Fax: 313-582-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003927
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4901003927
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: WALTER J CUKROWSKI
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 248-352-2806