Healthcare Provider Details

I. General information

NPI: 1649313305
Provider Name (Legal Business Name): MICHIGAN EYECARE OPTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 W LAKE LANSING RD
EAST LANSING MI
48823-8526
US

IV. Provider business mailing address

2001 COOLIDGE RD
EAST LANSING MI
48823-1378
US

V. Phone/Fax

Practice location:
  • Phone: 517-333-3940
  • Fax: 517-333-6535
Mailing address:
  • Phone: 517-333-3940
  • Fax: 517-333-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES D DOBIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 517-337-1496