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General NPI Number Information
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NPI Number | 1962534990
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Entity Type | Organization
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Legal Business Name | THOMAS B PARDEE
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 09/11/2008
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Provider Practice Location Address
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Address Line | 4091 RICHFIELD RD
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City | FLINT
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State | MI
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Zip | 48506-2033
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Country | US
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Telephone | 810-736-0710
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Fax | 810-736-2713
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Provider Business Mailing Address
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Address Line | 4091 RICHFIELD RD
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City | FLINT
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State | MI
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Zip | 48506-2033
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Country | US
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Telephone | 810-736-0710
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Fax | 810-736-2713
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS B PARDEE
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Credential | O.D.
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Telephone | 810-736-0710
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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 | 4901002600
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License Number State | MI
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