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General NPI Number Information
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NPI Number | 1063556215
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Entity Type | Organization
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Legal Business Name | MICHIGAN EYE INSTITUTE OPTICAL
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 4499 TOWN CENTER PKWY
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City | FLINT
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State | MI
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Zip | 48532-3425
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Country | US
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Telephone | 810-733-7111
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Fax | 810-733-7141
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Provider Business Mailing Address
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Address Line | 4499 TOWN CENTER PKWY
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City | FLINT
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State | MI
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Zip | 48532-3425
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Country | US
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Telephone | 810-733-7111
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Fax | 810-733-7141
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY A DISKIN
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Credential | MD
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Telephone | 810-733-7111
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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 |
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License Number State |
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