Healthcare Provider Details

I. General information

NPI: 1952215741
Provider Name (Legal Business Name): MYEYEDR OPTOMETRY OF MICHIGAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20525 MACK AVE
GROSSE POINTE WOODS MI
48236-1655
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 313-881-6622
  • Fax: 313-881-9380
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SUE ANN DOWNES
Title or Position: SECRETARY
Credential:
Phone: 785-492-5871