Healthcare Provider Details

I. General information

NPI: 1922274281
Provider Name (Legal Business Name): P-COR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7230 ORCHARD LAKE RD
W BLOOMFIELD MI
48322-3603
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 248-661-5100
  • Fax:
Mailing address:
  • Phone: 248-588-9300
  • Fax: 248-307-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateMI

VIII. Authorized Official

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