Healthcare Provider Details

I. General information

NPI: 1366356800
Provider Name (Legal Business Name): EYEQ VISION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 W MAPLE RD STE 107
WEST BLOOMFIELD MI
48322-4415
US

IV. Provider business mailing address

6195 SUNNYDALE RD
CLARKSTON MI
48346-2334
US

V. Phone/Fax

Practice location:
  • Phone: 248-904-8100
  • Fax:
Mailing address:
  • Phone: 248-904-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LAUREN ELIZABETH RODERICK
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 248-904-8100