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General NPI Number Information
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NPI Number | 1518145697
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Entity Type | Organization
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Legal Business Name | FOX OPTICAL, INC.
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 137 S LIVERNOIS RD
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-1837
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Country | US
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Telephone | 248-652-0600
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Fax | 248-652-2661
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Provider Business Mailing Address
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Address Line | 137 S LIVERNOIS RD
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-1837
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Country | US
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Telephone | 248-652-0600
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Fax | 248-652-2661
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Authorized Official
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Title or Position | MANAGER
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Name | GEORGE FOX
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Credential |
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Telephone | 248-652-0600
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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 | 4901002263
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License Number State | MI
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