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General NPI Number Information
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NPI Number | 1972927481
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Entity Type | Organization
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Legal Business Name | INFINITY EYE CARE, INC
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Dates
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Enumeration Date | 02/05/2014
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 932 SPRING ST STE 201
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City | PETOSKEY
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State | MI
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Zip | 49770-2286
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Country | US
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Telephone | 231-622-4779
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Fax | 231-622-4686
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Provider Business Mailing Address
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Address Line | 932 SPRING ST STE 201
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City | PETOSKEY
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State | MI
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Zip | 49770-2286
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Country | US
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Telephone | 231-622-4779
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Fax | 231-622-4686
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Authorized Official
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Title or Position | OWNER
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Name | DR. THERESIA LOUISE SOBCZAK
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Credential | OD
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Telephone | 231-758-2020
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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 | 4901003923
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License Number State | MI
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