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General NPI Number Information
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NPI Number | 1689014573
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Entity Type | Organization
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Legal Business Name | EYE 2 EYE CONTACT
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Dates
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Enumeration Date | 06/25/2013
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Last Update Date | 06/25/2013
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Provider Practice Location Address
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Address Line | 723 RIVER PARK VILLAGE BLVD MOBILE UNIT DISPENSARY
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City | NORTHVILLE
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State | MI
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Zip | 48167-2777
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Country | US
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Telephone | 313-378-7883
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Fax |
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Provider Business Mailing Address
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Address Line | 723 RIVER PARK VILLAGE BLVD MOBILE UNIT DISPENSARY
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City | NORTHVILLE
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State | MI
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Zip | 48167-2777
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTICIAN
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Name | WILLIE DARE TAYLOR
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Credential | ABOC,NCLEC,MBOC
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Telephone | 313-378-7883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 151016
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License Number State | MI
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