Healthcare Provider Details

I. General information

NPI: 1861786758
Provider Name (Legal Business Name): HOLICKI OPTICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 S LAKEVIEW AVE
STURGIS MI
49091-2350
US

IV. Provider business mailing address

142 E CHICAGO RD STE B
COLDWATER MI
49036-8449
US

V. Phone/Fax

Practice location:
  • Phone: 269-651-4545
  • Fax:
Mailing address:
  • Phone: 517-279-6335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH HOLICKI
Title or Position: OWNER
Credential: DO
Phone: 517-279-6335