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General NPI Number Information
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NPI Number | 1346407889
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Entity Type | Organization
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Legal Business Name | DOUGLAS FRASER VISION CENTER
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 38110 MICHIGAN AVE
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City | WAYNE
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State | MI
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Zip | 48184-2842
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Country | US
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Telephone | 734-728-5940
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Fax |
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Provider Business Mailing Address
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Address Line | 38110 MICHIGAN AVE
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City | WAYNE
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State | MI
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Zip | 48184-2842
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Country | US
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Telephone | 734-728-5940
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | GUY FLANNERY
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Credential |
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Telephone | 248-203-1100
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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 | 4901002413
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License Number State | MI
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