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General NPI Number Information
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NPI Number | 1720262215
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Entity Type | Organization
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Legal Business Name | DELTAVISION OPTICAL
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 12/20/2007
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Provider Practice Location Address
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Address Line | 934 ELMWOOD RD
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City | LANSING
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State | MI
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Zip | 48917-2070
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Country | US
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Telephone | 517-886-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 934 ELMWOOD RD
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City | LANSING
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State | MI
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Zip | 48917-2070
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Country | US
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Telephone | 517-886-0222
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY POPOWITZ
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Credential | OD
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Telephone | 517-886-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 4901003607
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License Number State | MI
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