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General NPI Number Information
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NPI Number | 1689077471
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Entity Type | Organization
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Legal Business Name | EYES ON MIDTOWN, PC
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 71 GARFIELD ST
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City | DETROIT
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State | MI
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Zip | 48201-1905
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Country | US
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Telephone | 313-316-0120
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Fax |
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Provider Business Mailing Address
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Address Line | 71 GARFIELD ST
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City | DETROIT
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State | MI
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Zip | 48201-1905
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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 | OWNER
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Name | TIFFANY R HUMES
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Credential | O.D.
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Telephone | 313-316-0120
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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 | 4901003785
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004672
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License Number State | MI
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