Healthcare Provider Details

I. General information

NPI: 1568197820
Provider Name (Legal Business Name): CUSTOM VISION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 W UNIVERSITY DR STE 155
ROCHESTER MI
48307-1871
US

IV. Provider business mailing address

1135 W UNIVERSITY DR STE 155
ROCHESTER MI
48307-1871
US

V. Phone/Fax

Practice location:
  • Phone: 248-710-2325
  • Fax: 248-266-8293
Mailing address:
  • Phone: 248-710-2325
  • Fax: 248-266-8293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA VRABEC
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 248-710-2325