Healthcare Provider Details

I. General information

NPI: 1609042035
Provider Name (Legal Business Name): PCOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19683 MACK AVE
GROSSE POINTE WOODS MI
48236-2501
US

IV. Provider business mailing address

735 JOHN R RD STE 150
TROY MI
48083-5859
US

V. Phone/Fax

Practice location:
  • Phone: 313-822-6000
  • Fax: 313-822-6009
Mailing address:
  • Phone: 248-588-9300
  • Fax: 248-307-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateMI

VIII. Authorized Official

Name: MRS. GAIL ELIAS
Title or Position: VP
Credential:
Phone: 248-577-3624