| NPI | 1609042035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAKIA TISDALE Credentialing 248-577-3659 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2026-07-10 |