Healthcare Provider Details

I. General information

NPI: 1609048172
Provider Name (Legal Business Name): KOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5660 DIXIE HWY
WATERFORD MI
48329-1695
US

IV. Provider business mailing address

5660 DIXIE HWY
WATERFORD MI
48329-1695
US

V. Phone/Fax

Practice location:
  • Phone: 248-623-1876
  • Fax:
Mailing address:
  • Phone: 248-623-1876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: JANIS BEHEN
Title or Position: OPTICIAN
Credential:
Phone: 248-623-1876