Provider Demographics
NPI:1053460311
Name:ALLISON EYE CARE INC
Entity Type:Organization
Organization Name:ALLISON EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:MB
Authorized Official - Last Name:SCHULTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-922-1111
Mailing Address - Street 1:6770 DIXIE HWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346
Mailing Address - Country:US
Mailing Address - Phone:248-922-1111
Mailing Address - Fax:248-922-9962
Practice Address - Street 1:6770 DIXIE HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346
Practice Address - Country:US
Practice Address - Phone:248-922-1111
Practice Address - Fax:248-922-9962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003620152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU44794Medicare UPIN
MIOF36504Medicare ID - Type Unspecified