Healthcare Provider Details

I. General information

NPI: 1144694241
Provider Name (Legal Business Name): HARRISON EYE CARE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 S 1ST ST
HARRISON MI
48625-2500
US

IV. Provider business mailing address

PO BOX 90
HARRISON MI
48625-0090
US

V. Phone/Fax

Practice location:
  • Phone: 989-539-2020
  • Fax: 989-539-2461
Mailing address:
  • Phone: 989-539-2020
  • Fax: 989-539-2461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number4901004834
License Number StateMI

VIII. Authorized Official

Name: SARAH BROZZO
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 989-708-5978