Healthcare Provider Details

I. General information

NPI: 1477627131
Provider Name (Legal Business Name): FAMILY EYE CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5590 MAIN STREET SUITE 1
LEXINGTON MI
48450
US

IV. Provider business mailing address

5590 MAIN ST., SUITE 1 PO BOX 51
LEXINGTON MI
48450
US

V. Phone/Fax

Practice location:
  • Phone: 810-359-2020
  • Fax: 810-359-8720
Mailing address:
  • Phone: 810-359-2020
  • Fax: 810-359-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004203
License Number StateMI

VIII. Authorized Official

Name: DR. JACQUELINE MICHELLE SCARBROUGH
Title or Position: PRESIDENT
Credential: O.D.
Phone: 810-359-2020