MEDICARE: SVS VISION INC

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	332H00000X	Eyewear Supplier
2	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972153666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SVS VISION INC

Provider Business Mailing Address
First Line	:	118 CASS AVE
Second Line	:
City	:	MOUNT CLEMENS
State	:	MI
Zip	:	48043-2204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15620 HALL RD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-1036
Country	:	US
Telephone Number	:	586-676-9000
Fax Number	:	586-408-6038

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT GUY FARRELL
Credential	:	OD
Telephone Number	:	586-468-7370

Provider Enumeration Date	:	09/16/2019
Last Update Date	:	12/11/2019

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Directions to “SVS VISION INC ” Practice Location

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