Healthcare Provider Details

I. General information

NPI: 1194190918
Provider Name (Legal Business Name): SVS VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36824 VAN DYKE AVE
STERLING HEIGHTS MI
48312-2770
US

IV. Provider business mailing address

118 CASS AVE
MOUNT CLEMENS MI
48043-2204
US

V. Phone/Fax

Practice location:
  • Phone: 586-276-9300
  • Fax: 586-261-5094
Mailing address:
  • Phone: 586-468-7370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: ROBERT G FARRELL JR.
Title or Position: OWNER
Credential: OD
Phone: 586-468-7370