Provider Demographics
NPI:1124189089
Name:NORMANDY OPTICAL COMPANY, INC
Entity Type:Organization
Organization Name:NORMANDY OPTICAL COMPANY, INC
Other - Org Name:NORMANDY OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SESTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:586-775-6733
Mailing Address - Street 1:23620 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1448
Mailing Address - Country:US
Mailing Address - Phone:586-775-6733
Mailing Address - Fax:586-775-0397
Practice Address - Street 1:23620 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1448
Practice Address - Country:US
Practice Address - Phone:586-775-6733
Practice Address - Fax:586-775-0397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900E066130OtherBCBS OF MI
MI0N33740Medicare ID - Type UnspecifiedMEDICARE PART B
MI0219840001Medicare NSC