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General NPI Number Information
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NPI Number | 1568714855
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Entity Type | Organization
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Legal Business Name | CHILDREN'S EYE CARE, PC
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Dates
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Enumeration Date | 10/10/2012
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Last Update Date | 10/22/2012
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Provider Practice Location Address
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Address Line | 3901 BEAUBIEN ST
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City | DETROIT
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State | MI
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Zip | 48201-2119
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Country | US
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Telephone | 313-745-3937
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Fax | 313-745-0401
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Provider Business Mailing Address
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Address Line | 6689 ORCHARD LAKE RD # 297
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3404
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Country | US
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Telephone | 248-254-8140
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Fax | 248-254-8150
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | AMY SOKOL
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Credential |
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Telephone | 248-254-8140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 4901003317
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License Number State | MI
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