Healthcare Provider Details

I. General information

NPI: 1740050004
Provider Name (Legal Business Name): IZODAWN EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 W SAGINAW HWY
LANSING MI
48917-2625
US

IV. Provider business mailing address

5020 W SAGINAW HWY
LANSING MI
48917-2625
US

V. Phone/Fax

Practice location:
  • Phone: 517-323-3399
  • Fax:
Mailing address:
  • Phone: 517-323-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CLEMENT NWADOZI
Title or Position: CEO
Credential: OD
Phone: 517-323-3399