Healthcare Provider Details

I. General information

NPI: 1154436335
Provider Name (Legal Business Name): LIVINGSTON EYECARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7486 EAST M-36
HAMBURG MI
48139
US

IV. Provider business mailing address

PO BOX 767
HAMBURG MI
48139-0767
US

V. Phone/Fax

Practice location:
  • Phone: 810-231-5800
  • Fax: 810-231-6422
Mailing address:
  • Phone: 810-231-5800
  • Fax: 810-231-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4901003817
License Number StateMI

VIII. Authorized Official

Name: DR. CHAD R GALLATIN
Title or Position: MEMBER, LLC / OPTOMETRIST
Credential: O.D.
Phone: 810-231-5800