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General NPI Number Information
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NPI Number | 1922428887
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Entity Type | Organization
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Legal Business Name | P-COR, LLC
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Dates
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Enumeration Date | 04/18/2014
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Last Update Date | 01/22/2018
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Provider Practice Location Address
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Address Line | 400 RENAISSANCE CTR STE 1402
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City | DETROIT
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State | MI
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Zip | 48243-1502
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Country | US
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Telephone | 313-324-8100
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Fax | 313-567-2568
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Provider Business Mailing Address
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Address Line | 735 JOHN R RD STE 150
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City | TROY
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State | MI
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Zip | 48083-5859
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Country | US
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Telephone | 248-588-9300
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Fax | 248-588-3355
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Authorized Official
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Title or Position | VP
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Name | GAIL ELIAS
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Credential |
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Telephone | 248-577-3624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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