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General NPI Number Information
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NPI Number | 1417121724
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Entity Type | Organization
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Legal Business Name | TWINSITE OPTICAL LLC
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 318 S MAIN ST
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City | ROCHESTER
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State | MI
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Zip | 48307-2030
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Country | US
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Telephone | 248-608-0055
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Fax |
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Provider Business Mailing Address
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Address Line | 318 S MAIN ST
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City | ROCHESTER
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State | MI
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Zip | 48307-2030
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Country | US
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Telephone | 248-608-0055
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY JOHN NOWAK
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Credential |
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Telephone | 248-608-0055
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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 |
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License Number State |
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