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General NPI Number Information
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NPI Number | 1568508398
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Entity Type | Organization
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Legal Business Name | NATIONAL EYEWEAR OUTLET OF WARREN
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3200 E 12 MILE RD SUITE 104
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City | WARREN
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State | MI
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Zip | 48092-5621
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Country | US
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Telephone | 586-558-3059
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Fax | 586-558-3067
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Provider Business Mailing Address
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Address Line | 3200 E 12 MILE RD SUITE 104
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City | WARREN
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State | MI
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Zip | 48092-5621
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Country | US
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Telephone | 586-558-3059
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Fax | 586-558-3067
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Authorized Official
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Title or Position | VICE PRESIDENT-OPTICIAN
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Name | MRS. SHERRIE ANN HICKS
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Credential |
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Telephone | 586-558-3059
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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 | B
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License Number State | MI
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