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General NPI Number Information
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NPI Number | 1790310332
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Entity Type | Organization
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Legal Business Name | PRISM PARK OPTICAL STUDIO
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Dates
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Enumeration Date | 03/04/2020
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 23411 JOHN R RD STE 4
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City | HAZEL PARK
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State | MI
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Zip | 48030-1404
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Country | US
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Telephone | 248-325-8009
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Fax |
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Provider Business Mailing Address
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Address Line | 1770 E GRANET AVE
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City | HAZEL PARK
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State | MI
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Zip | 48030-2108
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Country | US
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Telephone | 248-971-8590
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | FRANKLIN SCHREIBMAN
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Credential |
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Telephone | 248-971-8590
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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 |
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License Number State |
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