| |
29660 S Wixom Rd, Wixom, MI 48393-3430 | |
(248) 313-5500 | |
(248) 313-5510 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 29660 S Wixom Rd, Wixom, Michigan |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1073908174 | NPI | - | NPPES |
4500481 | Medicaid | MI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Primary |
332H00000X | Eyewear Supplier | (Michigan) | Secondary |
Mailing Address | Practice Location Address |
---|---|
118 Cass Ave, Mount Clemens, MI 48043-2204 Ph: (586) 464-1479 | 29660 S Wixom Rd, Wixom, MI 48393-3430 Ph: (248) 313-5500 |