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General NPI Number Information
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NPI Number | 1467625673
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Entity Type | Organization
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Legal Business Name | BAYVIEW OPTICAL INC
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 02/27/2017
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Provider Practice Location Address
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Address Line | 33012 7 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48152-1358
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Country | US
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Telephone | 248-482-2020
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Fax | 248-476-6441
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Provider Business Mailing Address
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Address Line | 33012 7 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48152-1358
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Country | US
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Telephone | 248-482-2020
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Fax | 248-476-6441
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GERALD NORMAN BLAIZE
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Credential | O.D.
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Telephone | 248-482-2020
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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 | 4901003562
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License Number State | MI
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