Healthcare Provider Details

I. General information

NPI: 1942641386
Provider Name (Legal Business Name): SVS VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 MARSH RD SPACE #5
OKEMOS MI
48864-1153
US

IV. Provider business mailing address

118 CASS AVE
MOUNT CLEMENS MI
48043-2204
US

V. Phone/Fax

Practice location:
  • Phone: 517-709-8010
  • Fax: 517-709-8049
Mailing address:
  • Phone: 586-468-7370
  • Fax: 586-468-7676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT G FARRELL JR.
Title or Position: CEO/OWNER
Credential: OD
Phone: 586-468-7370