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General NPI Number Information
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NPI Number | 1255517843
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Entity Type | Organization
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Legal Business Name | SHARP IMAGE OPTICAL INC.
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 19335 ALLEN RD
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City | BROWNSTOWN TWP
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State | MI
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Zip | 48183-1003
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Country | US
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Telephone | 734-479-5585
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Fax | 734-479-5586
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Provider Business Mailing Address
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Address Line | 19335 ALLEN RD
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City | BROWNSTOWN TWP
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State | MI
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Zip | 48183-1003
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Country | US
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Telephone | 734-479-5585
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Fax | 734-479-5586
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Authorized Official
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Title or Position | OWNER
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Name | KAMAL GUPTA
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Credential | M.D.
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Telephone | 734-479-5585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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