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General NPI Number Information
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NPI Number | 1689716490
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Entity Type | Organization
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Legal Business Name | METRO VISION II,INC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 39087 GARFIELD RD
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-2789
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Country | US
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Telephone | 586-286-7200
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Fax | 586-286-4144
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Provider Business Mailing Address
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Address Line | 39087 GARFIELD RD
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-2789
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Country | US
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Telephone | 586-286-7200
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Fax | 586-286-4144
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL JOSEPH LICAVOLI
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Credential | ABOC
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Telephone | 586-286-7200
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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 |
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License Number State |
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