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General NPI Number Information
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NPI Number | 1821383613
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Entity Type | Organization
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Legal Business Name | EYECARE PROFESSIONALS OF MICHIGAN
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Dates
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Enumeration Date | 06/09/2011
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Last Update Date | 06/09/2011
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Provider Practice Location Address
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Address Line | 18900 MICHIGAN AVE SUITE 1001
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City | DEARBORN
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State | MI
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Zip | 48126-3929
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Country | US
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Telephone | 313-271-0383
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Fax |
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Provider Business Mailing Address
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Address Line | 28024 BRIAR HILL DR
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-2214
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Country | US
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Telephone | 248-497-9904
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. THERESA PALMA VOYLES
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Credential | O.D.
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Telephone | 248-497-9904
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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 | 4901003309
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License Number State | MI
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