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General NPI Number Information
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NPI Number | 1902247208
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Entity Type | Organization
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Legal Business Name | MVC ACQUISITION OF STERLING HEIGHTS PLC
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 11445 15 MILE RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48312-3809
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Country | US
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Telephone | 586-268-5804
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Fax |
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Provider Business Mailing Address
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Address Line | 11445 15 MILE RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48312-3809
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. ANDREA K BRADEN
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Credential | O.D.
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Telephone | 734-693-2874
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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 | 4901004563
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License Number State | MI
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