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General NPI Number Information
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NPI Number | 1063544799
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Entity Type | Organization
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Legal Business Name | FOURMILE EYE CARE, LLC
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 35000 WARREN RD SEARS OPTICAL
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City | WESTLAND
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State | MI
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Zip | 48185-6223
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Country | US
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Telephone | 734-425-1190
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Fax |
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Provider Business Mailing Address
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Address Line | 10223 E AVONDALE CIR
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City | SUPERIOR TOWNSHIP
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State | MI
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Zip | 48198-2600
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NEIL DELEDDA
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Credential |
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Telephone | 734-485-4306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004194
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License Number State | MI
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