Healthcare Provider Details

I. General information

NPI: 1346543840
Provider Name (Legal Business Name): SALINE OPTOMETRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E MICHIGAN AVE
SALINE MI
48176-1552
US

IV. Provider business mailing address

121 E MICHIGAN AVE
SALINE MI
48176-1552
US

V. Phone/Fax

Practice location:
  • Phone: 734-429-9454
  • Fax: 734-429-4100
Mailing address:
  • Phone: 734-429-9454
  • Fax: 734-429-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004009
License Number StateMI

VIII. Authorized Official

Name: DR. BRIAN C HAYES
Title or Position: PRESIDENT
Credential: O.D.
Phone: 734-429-9454