Healthcare Provider Details

I. General information

NPI: 1538179080
Provider Name (Legal Business Name): M.D. OPTICAL, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 BARCLAY CIR
ROCHESTER HILLS MI
48307-4511
US

IV. Provider business mailing address

375 BARCLAY CIR
ROCHESTER HILLS MI
48307-4511
US

V. Phone/Fax

Practice location:
  • Phone: 248-852-3636
  • Fax: 248-852-3631
Mailing address:
  • Phone: 248-852-3636
  • Fax: 248-852-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANK NELSON DERR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-852-3636