| NPI | 1265699516 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW EALOVEGA Doctor Of Optomerty 734-453-4870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI 4901003867) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2018-08-20 |