Healthcare Provider Details

I. General information

NPI: 1386667517
Provider Name (Legal Business Name): TERRENCE NORTON DONOVAN B.C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33612 SCHOOLCRAFT RD
LIVONIA MI
48150-1540
US

IV. Provider business mailing address

33612 SCHOOLCRAFT RD
LIVONIA MI
48150-1540
US

V. Phone/Fax

Practice location:
  • Phone: 734-425-3430
  • Fax: 734-425-8090
Mailing address:
  • Phone: 734-425-3430
  • Fax: 734-425-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number5001000008
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: