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General NPI Number Information
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NPI Number | 1790953248
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Entity Type | Organization
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Legal Business Name | LIVINGSTON COUNTY VISION CENTER
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 05/07/2014
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Provider Practice Location Address
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Address Line | 2674 E GRAND RIVER AVE
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City | HOWELL
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State | MI
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Zip | 48843-8544
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Country | US
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Telephone | 517-546-9242
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Fax | 517-546-7840
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Provider Business Mailing Address
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Address Line | 2674 E GRAND RIVER AVE
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City | HOWELL
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State | MI
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Zip | 48843-8544
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Country | US
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Telephone | 517-546-9242
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Fax | 517-546-7840
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. CHAD ROBERT NIXON
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Credential | O.D.
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Telephone | 517-546-9242
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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 | 4901004200
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License Number State | MI
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