Healthcare Provider Details

I. General information

NPI: 1114223377
Provider Name (Legal Business Name): CHEAPER PEEPERS OF NEW YORK MDIV, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 COOLIDGE HWY
ROYAL OAK MI
48073-1001
US

IV. Provider business mailing address

203 NEWBRIDGE RD
HITCKSVILLE NY
11801-3933
US

V. Phone/Fax

Practice location:
  • Phone: 248-435-4200
  • Fax: 248-288-2124
Mailing address:
  • Phone: 248-719-7554
  • Fax: 248-719-7564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332G00000X
TaxonomyEye Bank
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANA MANSUY
Title or Position: MANAGED CARE MANAGER
Credential:
Phone: 248-719-7554