Provider Demographics
NPI:1043209349
Name:OAKLAND EYEWEAR
Entity Type:Organization
Organization Name:OAKLAND EYEWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY / TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:NONA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PODSCHLNE
Authorized Official - Suffix:
Authorized Official - Credentials:DISPENSING OPTICIAN
Authorized Official - Phone:734-287-3663
Mailing Address - Street 1:15055 S PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-5202
Mailing Address - Country:US
Mailing Address - Phone:734-287-3663
Mailing Address - Fax:734-287-1074
Practice Address - Street 1:15055 S PLAZA DR
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5202
Practice Address - Country:US
Practice Address - Phone:734-287-3663
Practice Address - Fax:734-287-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0407460001Medicare ID - Type Unspecified