Provider Demographics
NPI:1003803990
Name:GENERAL OPTICAL COMPANY
Entity Type:Organization
Organization Name:GENERAL OPTICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-744-1950
Mailing Address - Street 1:405 GARLAND ST
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1235 S CENTER RD
Practice Address - Street 2:SUITE 16
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1700
Practice Address - Country:US
Practice Address - Phone:810-744-1950
Practice Address - Fax:810-744-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0983566Medicaid
MI0983566Medicaid