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General NPI Number Information
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NPI Number | 1225269590
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Entity Type | Organization
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Legal Business Name | MEDICAL EYE CLINIC, PLLC
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Dates
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Enumeration Date | 08/04/2009
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Last Update Date | 08/31/2012
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Provider Practice Location Address
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Address Line | 1621 E M 21
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City | OWOSSO
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State | MI
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Zip | 48867-9053
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Country | US
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Telephone | 989-729-1519
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Fax | 989-728-7823
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Provider Business Mailing Address
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Address Line | 1621 E M 21
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City | OWOSSO
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State | MI
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Zip | 48867-9053
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Country | US
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Telephone | 989-729-1519
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Fax | 989-728-7823
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. GARY H. STOLICKER
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Credential | O.D.
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Telephone | 989-729-1519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4901004432
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License Number State | MI
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