Healthcare Provider Details

I. General information

NPI: 1275588840
Provider Name (Legal Business Name): SHELBY EYECARE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48187 VAN DYKE AVE
SHELBY TOWNSHIP MI
48317-3268
US

IV. Provider business mailing address

48187 VAN DYKE AVE
SHELBY TOWNSHIP MI
48317-3268
US

V. Phone/Fax

Practice location:
  • Phone: 586-739-9550
  • Fax: 586-739-0083
Mailing address:
  • Phone: 586-739-9550
  • Fax: 586-739-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4901003013
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number4901003013
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number4901003013
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number4901003013
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number4901003013
License Number StateMI
# 6
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003013
License Number StateMI

VIII. Authorized Official

Name: MRS. MARIE DORAU
Title or Position: OFFICE MANAGER
Credential:
Phone: 586-739-9550