Healthcare Provider Details

I. General information

NPI: 1831438746
Provider Name (Legal Business Name): OPTOMETRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57970 VAN DYKE RD
WASHINGTON TWP MI
48094-2883
US

IV. Provider business mailing address

42550 GARFIELD RD STE. 101
CLINTON TWP MI
48038-1644
US

V. Phone/Fax

Practice location:
  • Phone: 586-677-6384
  • Fax: 586-677-9256
Mailing address:
  • Phone: 586-263-9708
  • Fax: 586-263-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003900
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003953
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003968
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003988
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002754
License Number StateMI

VIII. Authorized Official

Name: DR. DONALD WILLIAM LAKIN
Title or Position: PRESIDENT/OWNER
Credential: O.D.
Phone: 586-263-9708