Healthcare Provider Details

I. General information

NPI: 1154336931
Provider Name (Legal Business Name): SPECIAL NEEDS VISION CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 SOUTHFIELD DR
SAGINAW MI
48601-5653
US

IV. Provider business mailing address

3660 SOUTHFIELD DR
SAGINAW MI
48601-5653
US

V. Phone/Fax

Practice location:
  • Phone: 989-777-1040
  • Fax: 989-777-3509
Mailing address:
  • Phone: 989-777-1040
  • Fax: 989-777-3509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. DOLORES J. KOWALSKI
Title or Position: EXECUTIVE DIRECTOR
Credential: O.D.
Phone: 989-777-1040