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General NPI Number Information
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NPI Number | 1366130148
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Entity Type | Organization
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Legal Business Name | COMMERCE OPTOMETRY, PLLC
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Dates
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Enumeration Date | 04/28/2023
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 3000 COMMERCE XING
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City | COMMERCE TOWNSHIP
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State | MI
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Zip | 48390-3082
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Country | US
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Telephone | 248-529-2306
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Fax | 248-529-2328
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Provider Business Mailing Address
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Address Line | 3205 SEQUOIA CT
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City | MILFORD
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State | MI
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Zip | 48380-3461
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Country | US
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Telephone | 517-896-8616
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | ERICA KERNEY
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Credential | OD
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Telephone | 517-896-8616
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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 |
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License Number State |
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