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General NPI Number Information
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NPI Number | 1245317288
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Entity Type | Organization
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Legal Business Name | JOSEPH D SCHWALLIE OD, INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 7317 LEWIS AVE
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City | TEMPERANCE
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State | MI
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Zip | 48182-1216
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Country | US
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Telephone | 734-847-4575
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Fax |
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Provider Business Mailing Address
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Address Line | 7317 LEWIS AVE
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City | TEMPERANCE
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State | MI
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Zip | 48182-1216
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Country | US
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Telephone | 734-847-4575
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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. JOE D SCHWALLIE
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Credential | OD
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Telephone | 734-847-4575
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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 | 4901004560
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License Number State | MI
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