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General NPI Number Information
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NPI Number | 1629886270
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Entity Type | Organization
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Legal Business Name | UNIQUELY SPECIAL OPTICAL LLC
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Dates
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Enumeration Date | 12/27/2024
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 15370 GRAND RIVER AVE
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City | DETROIT
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State | MI
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Zip | 48227-2215
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Country | US
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Telephone | 248-818-6702
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Fax |
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Provider Business Mailing Address
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Address Line | 24554 GROVE AVE
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City | EASTPOINTE
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State | MI
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Zip | 48021-1031
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Country | US
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Telephone | 248-818-6702
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. MONIQUE BROWN
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Credential |
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Telephone | 248-818-6702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1202X
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Taxonomy Name | Optometric Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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Taxonomy #3
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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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