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General NPI Number Information
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NPI Number | 1851594246
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Entity Type | Organization
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Legal Business Name | ERROL R CONGLETON OD PC
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 10/22/2008
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Provider Practice Location Address
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Address Line | 509 S SAGINAW RD
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City | MIDLAND
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State | MI
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Zip | 48640-4516
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Country | US
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Telephone | 989-835-2020
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Fax | 989-835-6192
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Provider Business Mailing Address
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Address Line | 509 S SAGINAW RD
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City | MIDLAND
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State | MI
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Zip | 48640-4516
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Country | US
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Telephone | 989-835-2020
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Fax | 989-835-6192
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. ERROL RAYMOND CONGLETON
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Credential | O.D.
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Telephone | 989-835-2020
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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 | 4901002565
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License Number State | MI
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