Healthcare Provider Details

I. General information

NPI: 1407223746
Provider Name (Legal Business Name): CLAUDIO HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 W VERNOR HWY
DETROIT MI
48209-2113
US

IV. Provider business mailing address

4220 W VERNOR HWY
DETROIT MI
48209-2113
US

V. Phone/Fax

Practice location:
  • Phone: 248-342-5361
  • Fax:
Mailing address:
  • Phone: 248-342-5361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER MAE CLAUDIO
Title or Position: OWNER/OPTOMETRIST
Credential: O.D.
Phone: 248-342-5361