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General NPI Number Information
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NPI Number | 1316107378
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Entity Type | Organization
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Legal Business Name | DP OPTICAL P C
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 670 S MAIN ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-1711
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Country | US
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Telephone | 734-446-6889
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Fax | 734-259-0804
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Provider Business Mailing Address
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Address Line | 51063 RICHARD DR
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City | PLYMOUTH
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State | MI
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Zip | 48170-1190
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Country | US
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Telephone | 734-446-6889
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Fax | 734-259-0804
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. DENNIS M PICARD
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Credential | O.D.
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Telephone | 734-560-7606
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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 | 4901003181
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License Number State | MI
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