Healthcare Provider Details

I. General information

NPI: 1053753368
Provider Name (Legal Business Name): HOMEBOUND EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2013
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11745 FOREST DR
PINCKNEY MI
48169-9538
US

IV. Provider business mailing address

11745 FOREST DR
PINCKNEY MI
48169-9538
US

V. Phone/Fax

Practice location:
  • Phone: 734-323-5253
  • Fax:
Mailing address:
  • Phone: 734-323-5253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004022
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number4901004022
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number4901004022
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number4901004022
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY MULLINS
Title or Position: PRESIDENT
Credential: OD
Phone: 734-323-5253