Healthcare Provider Details

I. General information

NPI: 1871780338
Provider Name (Legal Business Name): ABDELLA EYECARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 S LINDEN RD
FLINT MI
48532-4185
US

IV. Provider business mailing address

1356 S LINDEN RD
FLINT MI
48532-4185
US

V. Phone/Fax

Practice location:
  • Phone: 810-732-0202
  • Fax:
Mailing address:
  • Phone: 810-732-0202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4901002484
License Number StateMI

VIII. Authorized Official

Name: DR. JOHN PHILIP ABDELLA
Title or Position: PRESIDENT
Credential: OD
Phone: 810-732-0202