Healthcare Provider Details

I. General information

NPI: 1497996599
Provider Name (Legal Business Name): P-COR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22395 EUREKA RD
TAYLOR MI
48180-6016
US

IV. Provider business mailing address

735 JOHN R RD STE 150
TROY MI
48083-5859
US

V. Phone/Fax

Practice location:
  • Phone: 734-324-0996
  • Fax: 734-284-9335
Mailing address:
  • Phone: 248-588-9300
  • Fax: 248-781-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateMI

VIII. Authorized Official

Name: MRS. GAIL ELIAS
Title or Position: VP
Credential:
Phone: 248-577-3624