Healthcare Provider Details

I. General information

NPI: 1134246119
Provider Name (Legal Business Name): FLINT OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 11/03/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 S SAGINAW ST
FLINT MI
48502-1804
US

IV. Provider business mailing address

PO BOX 819
FLINT MI
48501-0819
US

V. Phone/Fax

Practice location:
  • Phone: 810-235-4607
  • Fax: 810-235-5232
Mailing address:
  • Phone: 810-235-4607
  • Fax: 810-235-5232

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: MRS. DIANE M PAYNE
Title or Position: OFFICE MANAGER
Credential:
Phone: 810-235-4607