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General NPI Number Information
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NPI Number | 1538784327
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Entity Type | Organization
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Legal Business Name | SASSY EYES BOUTIQUE, LLC
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 28911 7 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48152-3503
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Country | US
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Telephone | 248-777-1414
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Fax |
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Provider Business Mailing Address
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Address Line | 28911 7 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48152-3503
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Country | US
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Telephone | 248-777-1414
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL DWAYNE MULLINS
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Credential | OPTICIAN
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Telephone | 248-777-1414
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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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