Healthcare Provider Details

I. General information

NPI: 1538465117
Provider Name (Legal Business Name): HD OPTICAL EXPRESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5735 S CEDAR ST STE 1
LANSING MI
48911-5154
US

IV. Provider business mailing address

5735 S CEDAR ST STE 1
LANSING MI
48911-5154
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-2015
  • Fax: 517-882-2026
Mailing address:
  • Phone: 517-882-2015
  • Fax: 517-882-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDTR-2451048
License Number StateMI

VIII. Authorized Official

Name: DANIEL NASH
Title or Position: OWNER/OPTOMETRIST
Credential:
Phone: 517-882-2015