Healthcare Provider Details

I. General information

NPI: 1497721799
Provider Name (Legal Business Name): DIRECT OPTICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29321 ORCHARD LAKE RD
FARMINGTON HILLS MI
48334-2968
US

IV. Provider business mailing address

29321 ORCHARD LAKE RD
FARMINGTON HILLS MI
48334-2968
US

V. Phone/Fax

Practice location:
  • Phone: 248-553-8270
  • Fax: 248-553-8185
Mailing address:
  • Phone: 248-553-8270
  • Fax: 248-553-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS IRA CHAIKEN
Title or Position: PRESIDENT
Credential:
Phone: 248-553-8270