Healthcare Provider Details

I. General information

NPI: 1235264722
Provider Name (Legal Business Name): SVS VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19165 MACK AVE
GROSSE POINTE WOODS MI
48236-2803
US

IV. Provider business mailing address

118 CASS AVE
MOUNT CLEMENS MI
48043-2204
US

V. Phone/Fax

Practice location:
  • Phone: 313-882-7883
  • Fax: 313-882-5128
Mailing address:
  • Phone: 586-464-1479
  • Fax: 586-464-1480

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 StateMI

VIII. Authorized Official

Name: MR. ROBERT G FARRELL JR.
Title or Position: OWNER/CEO
Credential: OD
Phone: 586-468-7370