Healthcare Provider Details

I. General information

NPI: 1841429768
Provider Name (Legal Business Name): ONHEALTHCARE OPTOMETRY AND PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 KIRTS BLVD SUITE 200
TROY MI
48084-4899
US

IV. Provider business mailing address

1200 KIRTS BLVD SUITE 200
TROY MI
48084-4899
US

V. Phone/Fax

Practice location:
  • Phone: 248-528-1981
  • Fax: 614-416-2105
Mailing address:
  • Phone: 248-528-1981
  • Fax: 614-416-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number006416
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number005011
License Number StateNY

VIII. Authorized Official

Name: DR. ROBERT J LLOYD
Title or Position: OPTOMETRIST
Credential: OD
Phone: 248-528-1981