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General NPI Number Information
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NPI Number | 1417070392
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Entity Type | Organization
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Legal Business Name | FAMILY OPTOMETRY ASSOCIATES, P.C.
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Dates
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Enumeration Date | 04/07/2007
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Last Update Date | 07/07/2012
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Provider Practice Location Address
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Address Line | 26771 W 12 MILE RD SUITE 100
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1539
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Country | US
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Telephone | 248-263-4900
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Fax | 248-263-4903
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Provider Business Mailing Address
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Address Line | 26771 W 12 MILE RD SUITE 100
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1539
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Country | US
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Telephone | 248-263-4900
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Fax | 248-263-4903
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM JERRY LINDAHL
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Credential | O.D.
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Telephone | 248-263-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 4901002652
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License Number State | MI
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