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General NPI Number Information
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NPI Number | 1598075160
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Entity Type | Organization
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Legal Business Name | DIRECT OPTICAL OF CANTON, LLC
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 41840 FORD ROAD
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City | CANTON
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State | MI
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Zip | 48187
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Country | US
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Telephone | 734-981-1760
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Fax | 734-981-1574
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Provider Business Mailing Address
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Address Line | 41840 FORD ROAD
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City | CANTON
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State | MI
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Zip | 48187
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Country | US
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Telephone | 734-981-1760
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Fax | 734-981-1574
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARIANA MIHAJLOVSKI
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Credential |
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Telephone | 734-981-1760
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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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