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General NPI Number Information
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NPI Number | 1316338007
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Entity Type | Organization
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Legal Business Name | OWOSSO EYE CARE
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Dates
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Enumeration Date | 02/17/2015
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 122 N WASHINGTON ST
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City | OWOSSO
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State | MI
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Zip | 48867-2827
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Country | US
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Telephone | 989-723-8174
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Fax | 989-725-3123
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Provider Business Mailing Address
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Address Line | 122 N WASHINGTON ST
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City | OWOSSO
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State | MI
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Zip | 48867-2827
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Country | US
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Telephone | 989-723-8174
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Fax | 989-725-3123
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Authorized Official
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Title or Position | OWNER
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Name | DR. TOM HALL II
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Credential | OD
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Telephone | 989-424-0442
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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 | 4901004859
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License Number State | MI
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