Healthcare Provider Details

I. General information

NPI: 1538339940
Provider Name (Legal Business Name): MARTIN F GUINTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45260 VAN DYKE AVE
UTICA MI
48317-5672
US

IV. Provider business mailing address

45260 VAN DYKE AVE
UTICA MI
48317-5672
US

V. Phone/Fax

Practice location:
  • Phone: 586-731-1920
  • Fax: 586-731-8179
Mailing address:
  • Phone: 586-731-1920
  • Fax: 586-731-8179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARTIN FRANK GUINTA
Title or Position: OWNER
Credential: O.D
Phone: 586-731-1920