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General NPI Number Information
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NPI Number | 1841384674
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL VISION HEALTH LLC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 409 N. MARKETPLACE BLVD
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City | LANSING
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State | MI
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Zip | 48917
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Country | US
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Telephone | 517-622-5311
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Fax | 517-622-4291
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Provider Business Mailing Address
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Address Line | 3852 LYON RD
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City | MASON
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State | MI
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Zip | 48854
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Country | US
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Telephone | 517-628-2747
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JOHN AKERS
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Credential | O.D.
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Telephone | 517-628-2747
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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 | 4901003853
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License Number State | MI
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