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General NPI Number Information
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NPI Number | 1295864759
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Entity Type | Organization
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Legal Business Name | VILLAGE OPTICAL INC
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 05/15/2009
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Provider Practice Location Address
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Address Line | 16841 KERCHEVAL PL
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City | GROSSE POINTE PARK
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State | MI
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Zip | 48230-1553
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Country | US
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Telephone | 313-885-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 19992 COUNTRY CLUB DR
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City | HARPER WOODS
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State | MI
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Zip | 48225-1622
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Country | US
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Telephone | 313-885-1733
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Fax |
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Authorized Official
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Title or Position | DOCTOR OWNER
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Name | DR. MICHAEL LOWE
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Credential | O.D.
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Telephone | 313-885-5400
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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 | L907492
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License Number State | MI
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