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General NPI Number Information
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NPI Number | 1346414380
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Entity Type | Organization
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Legal Business Name | MILLMAN-DERR OPTICAL MACOMB, LTD.
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/02/2009
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Provider Practice Location Address
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Address Line | 17900 23 MILE RD SUITE #100
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City | MACOMB
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State | MI
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Zip | 48044
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Country | US
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Telephone | 586-416-1544
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Fax | 586-416-1520
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Provider Business Mailing Address
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Address Line | 375 BARCLAY CIR
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-4511
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Country | US
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Telephone | 248-852-3636
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Fax | 248-852-3631
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRANK NELSON DERR
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Credential | M.D.
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Telephone | 248-852-3636
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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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