MEDICARE: WISE EYES 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
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1770383580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISE EYES LLC

Provider Business Mailing Address
First Line	:	25211 COOLIDGE HWY
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-3165
Country	:	US
Telephone Number	:	248-545-2800
Fax Number	:	248-581-4074

Provider Business Practice Location Address
First Line	:	25211 COOLIDGE HWY
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-3165
Country	:	US
Telephone Number	:	248-545-2800
Fax Number	:	248-581-4074

Authorized Official
Title or Position	:	OWNER
Name	:	DR. YOCHEVED KRESCH
Credential	:	OD
Telephone Number	:	248-872-8125

Provider Enumeration Date	:	03/19/2025
Last Update Date	:	03/19/2025

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Directions to “WISE EYES LLC ” Practice Location

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