Healthcare Provider Details

I. General information

NPI: 1811421928
Provider Name (Legal Business Name): MICHIGAN EYE AND CONTACT LENS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42081 14 MILE ROAD
NOVI MI
48377
US

IV. Provider business mailing address

3768 DAMAS DR
COMMERCE TOWNSHIP MI
48382-4417
US

V. Phone/Fax

Practice location:
  • Phone: 248-655-7770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004809
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4901004809
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number4901004809
License Number StateMI

VIII. Authorized Official

Name: ALEXANDRA WILLIAMSON
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 248-655-7770