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NPI Code Detail

MEDICARE: PCOR LLC

MEDICARE: PCOR LLC
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
1332H00000XEyewear SupplierMI
2152W00000XOptometristMI

General Provider Information

NPI Number : 1689840043
Entity Type Code : Organization
Provider Name (Legal Business Name) : PCOR LLC
Provider Business Mailing Address
First Line : 735 JOHN R RD STE 150
Second Line :
City : TROY
State : MI
Zip : 48083-5859
Country : US
Telephone Number : 248-588-9300
Fax Number : 248-588-3355
Provider Business Practice Location Address
First Line : 35184 CENTRAL CITY PKWY
Second Line :
City : WESTLAND
State : MI
Zip : 48185-6215
Country : US
Telephone Number : 734-427-5200
Fax Number : 248-307-9518
Authorized Official
Title or Position : DIRECTOR OF FINANCE
Name : MRS. GAIL ELIAS
Credential :
Telephone Number : 248-577-3624
Provider Enumeration Date : 05/06/2008
Last Update Date : 01/22/2018

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