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General NPI Number Information
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NPI Number | 1083202154
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Entity Type | Organization
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Legal Business Name | LOCERNE OPTICAL LABS
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Dates
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Enumeration Date | 01/05/2021
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 28221 BECK RD STE A9
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City | WIXOM
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State | MI
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Zip | 48393-4701
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Country | US
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Telephone | 248-773-7330
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Fax |
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Provider Business Mailing Address
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Address Line | 28221 BECK RD STE A9
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City | WIXOM
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State | MI
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Zip | 48393-4701
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Country | US
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Telephone | 248-791-6620
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MR. ERIK PRESTON
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Credential |
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Telephone | 248-892-0190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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