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General NPI Number Information
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NPI Number | 1679754816
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Entity Type | Organization
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Legal Business Name | MICHIGAN EYECARE INSTITUTE, P.C.
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 29877 TELEGRAPH RD SUITE #100
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1332
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Country | US
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Telephone | 248-352-2806
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Fax |
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Provider Business Mailing Address
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Address Line | 29877 TELEGRAPH RD SUITE #100
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1332
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Country | US
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Telephone | 248-352-2806
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. KENDRA SUE STANTON
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Credential | B.S.
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Telephone | 248-352-2806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004206
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License Number State | MI
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