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General NPI Number Information
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NPI Number | 1730600602
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Entity Type | Organization
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Legal Business Name | E GAY EYE CARE PLLC
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Dates
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Enumeration Date | 06/30/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3050 UNION LAKE RD STE 3B
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City | COMMERCE TOWNSHIP
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State | MI
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Zip | 48382-4563
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Country | US
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Telephone | 248-716-3130
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Fax |
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Provider Business Mailing Address
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Address Line | 3050 UNION LAKE RD STE 3B
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City | COMMERCE TOWNSHIP
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State | MI
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Zip | 48382-4563
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Country | US
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Telephone | 248-716-3130
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | EDWIN GAY
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Credential | OD
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Telephone | 313-433-3037
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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 | 4901005051
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License Number State | MI
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