Provider Demographics
NPI:1083202154
Name:LOCERNE OPTICAL LABS
Entity Type:Organization
Organization Name:LOCERNE OPTICAL LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-892-0190
Mailing Address - Street 1:28221 BECK RD STE A9
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-4701
Mailing Address - Country:US
Mailing Address - Phone:248-791-6620
Mailing Address - Fax:
Practice Address - Street 1:28221 BECK RD STE A9
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-4701
Practice Address - Country:US
Practice Address - Phone:248-773-7330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier