Healthcare Provider Details

I. General information

NPI: 1932300928
Provider Name (Legal Business Name): VISION ASSOCIATES OF WESTLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38979 CHERRY HILL RD. SUITE B
WESTLAND MI
48186
US

IV. Provider business mailing address

38979 CHERRY HILL RD. SUITE B
WESTLAND MI
48186
US

V. Phone/Fax

Practice location:
  • Phone: 734-326-2160
  • Fax: 734-326-9678
Mailing address:
  • Phone: 734-326-2160
  • Fax: 734-326-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number4901002809
License Number StateMI

VIII. Authorized Official

Name: DR. RANDY G HOUDEK
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 734-326-2160