| NPI | 1518470855 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALIM KENETHA Owner 248-835-0496 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 156F00000X Technician/Technologist (Licence: 220452) |
| 261Q00000X Clinic/Center | |
| 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: MI 220452) | |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2022-11-07 |