MEDICARE: VISION INSTITUTE OF MICHIGAN PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1396828604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISION INSTITUTE OF MICHIGAN PC

Provider Business Mailing Address
First Line	:	44650 DELCO BLVD
Second Line	:
City	:	STERLING HTS
State	:	MI
Zip	:	48313-1063
Country	:	US
Telephone Number	:	586-254-1770
Fax Number	:	586-254-3515

Provider Business Practice Location Address
First Line	:	29691 6 MILE RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48152-8606
Country	:	US
Telephone Number	:	734-525-2229
Fax Number	:	734-525-3748

Authorized Official
Title or Position	:	CEO
Name	:	MR. MICHAEL RICHMOND
Credential	:
Telephone Number	:	586-254-1770

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	08/22/2020

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