Healthcare Provider Details

I. General information

NPI: 1437715091
Provider Name (Legal Business Name): ELIZABETH GRACE AVERY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2019
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E MICHIGAN AVE
SALINE MI
48176-1684
US

IV. Provider business mailing address

450 E MICHIGAN AVE
SALINE MI
48176-1684
US

V. Phone/Fax

Practice location:
  • Phone: 734-688-8052
  • Fax: 734-293-0910
Mailing address:
  • Phone: 734-688-8052
  • Fax: 734-293-0910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005728
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: