Healthcare Provider Details

I. General information

NPI: 1013197326
Provider Name (Legal Business Name): DONOVAN CONTACT LENS CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 12/05/2007
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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5001000008
License Number StateMI

VIII. Authorized Official

Name: MR. TERRENCE N. DONOVAN
Title or Position: OCULARIST
Credential: BCO
Phone: 734-425-3430