Provider Demographics
NPI:1205863727
Name:OPTOMETRY, P.C.
Entity Type:Organization
Organization Name:OPTOMETRY, P.C.
Other - Org Name:FAMILY EYE CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:586-263-9708
Mailing Address - Street 1:42550 GARFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1644
Mailing Address - Country:US
Mailing Address - Phone:586-263-9708
Mailing Address - Fax:586-263-0280
Practice Address - Street 1:42550 GARFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1644
Practice Address - Country:US
Practice Address - Phone:586-263-9708
Practice Address - Fax:586-263-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900E063150OtherBLUE CROSS BLUE SHIELD
MIOE06315OtherHEALTH ALLIANCE PLAN
MI230460OtherNATIONAL VISION ADMIN.
MI0E06315Medicare PIN
MI0229820002Medicare NSC