MEDICARE: SPECS EYEWEAR STUDIO 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	156FX1800X	Optician

General Provider Information

NPI Number	:	1912033481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECS EYEWEAR STUDIO LLC

Provider Business Mailing Address
First Line	:	2228 UNION LAKE RD
Second Line	:
City	:	COMMERCE TWP
State	:	MI
Zip	:	48382-2254
Country	:	US
Telephone Number	:	248-366-8600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2228 UNION LAKE RD
Second Line	:
City	:	COMMERCE TWP
State	:	MI
Zip	:	48382-2254
Country	:	US
Telephone Number	:	248-366-8600
Fax Number	:

Authorized Official
Title or Position	:	OPTICIAN OWNER
Name	:	DONNA M TARNAS
Credential	:
Telephone Number	:	248-366-8600

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	08/22/2020

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