| NPI | 1295807626 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENNY JACKSON Credentialing 517-202-1618 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: MI 4901002974) |
| 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: MI 4901004286) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2026-05-08 |