Provider Demographics
NPI:1003346651
Name:MY OPTICAL LIFE
Entity Type:Organization
Organization Name:MY OPTICAL LIFE
Other - Org Name:MY OPTICIAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:CURETON
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC OPTICIAN
Authorized Official - Phone:810-771-4064
Mailing Address - Street 1:7500 FENTON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7510
Mailing Address - Country:US
Mailing Address - Phone:810-771-4064
Mailing Address - Fax:810-771-4095
Practice Address - Street 1:7500 FENTON RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7510
Practice Address - Country:US
Practice Address - Phone:810-771-4064
Practice Address - Fax:810-771-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI156FC0800X, 156FX1100X, 156FX1201X, 156FX1800X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Multi-Specialty
No156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Multi-Specialty
No156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric AssistantGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty