Healthcare Provider Details

I. General information

NPI: 1114916848
Provider Name (Legal Business Name): EYES RIGHT OPTICALII, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26102 GREENFIELD RD
OAK PARK MI
48237-1050
US

IV. Provider business mailing address

26102 GREENFIELD RD
OAK PARK MI
48237-1050
US

V. Phone/Fax

Practice location:
  • Phone: 248-968-4224
  • Fax: 248-968-5127
Mailing address:
  • Phone: 248-968-4224
  • Fax: 248-968-5127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002664
License Number StateMI

VIII. Authorized Official

Name: DR. MARK ARTHUE LAVINE
Title or Position: OPTOMITIST
Credential: OD
Phone: 248-968-4223