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General NPI Number Information
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NPI Number | 1366356800
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Entity Type | Organization
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Legal Business Name | EYEQ VISION PLLC
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 5755 W MAPLE RD STE 107
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-4415
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Country | US
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Telephone | 248-904-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 6195 SUNNYDALE RD
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City | CLARKSTON
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State | MI
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Zip | 48346-2334
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Country | US
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Telephone | 248-904-8100
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. LAUREN ELIZABETH RODERICK
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Credential | OD
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Telephone | 248-904-8100
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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 | NULL
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