Healthcare Provider Details

I. General information

NPI: 1568714855
Provider Name (Legal Business Name): CHILDREN'S EYE CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

IV. Provider business mailing address

6689 ORCHARD LAKE RD # 297
WEST BLOOMFIELD MI
48322-3404
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-3937
  • Fax: 313-745-0401
Mailing address:
  • Phone: 248-254-8140
  • Fax: 248-254-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number4901003317
License Number StateMI

VIII. Authorized Official

Name: AMY SOKOL
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 248-254-8140