Healthcare Provider Details

I. General information

NPI: 1508032962
Provider Name (Legal Business Name): PCOR-LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 W OUTER DR
DETROIT MI
48235-3461
US

IV. Provider business mailing address

655 W 13 MILE RD
MADISON HTS MI
48071-1850
US

V. Phone/Fax

Practice location:
  • Phone: 313-387-8800
  • Fax: 248-307-9518
Mailing address:
  • Phone: 248-577-3616
  • Fax: 248-307-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. NANETTE MICHAELS
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 248-577-3662