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General NPI Number Information
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NPI Number | 1902152762
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Entity Type | Organization
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Legal Business Name | MID MICHIGAN FAMILY EYE CARE PLLC
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 06/28/2013
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Provider Practice Location Address
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Address Line | 1520 N MCEWAN ST # B
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City | CLARE
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State | MI
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Zip | 48617-1196
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Country | US
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Telephone | 989-386-2020
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Fax | 989-386-7308
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Provider Business Mailing Address
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Address Line | 1520 N MCEWAN ST STE B
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City | CLARE
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State | MI
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Zip | 48617-1196
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Country | US
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Telephone | 989-386-2020
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Fax | 989-386-7308
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. BRIAN MICHAEL HALES
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Credential | O.D.
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Telephone | 989-386-2020
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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 | 4901004640
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License Number State | MI
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