Healthcare Provider Details

I. General information

NPI: 1740278357
Provider Name (Legal Business Name): DETROIT OPTICAL CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32987 WOODWARD AVE
ROYAL OAK MI
48073-0958
US

IV. Provider business mailing address

32987 WOODWARD AVE
ROYAL OAK MI
48073-0958
US

V. Phone/Fax

Practice location:
  • Phone: 248-549-9080
  • Fax: 248-549-4770
Mailing address:
  • Phone: 248-549-9080
  • Fax: 248-549-4770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002916
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002904
License Number StateMI

VIII. Authorized Official

Name: DR. KENNETH B FOON
Title or Position: PRESIDENT
Credential: O.D.
Phone: 248-549-9080