Provider Demographics
NPI:1295818698
Name:VISION INSTITUTE OF MICHIGAN PC
Entity Type:Organization
Organization Name:VISION INSTITUTE OF MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-254-1770
Mailing Address - Street 1:44650 DELCO BLVD
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1063
Mailing Address - Country:US
Mailing Address - Phone:586-254-1770
Mailing Address - Fax:586-254-3515
Practice Address - Street 1:30795 23 MILE RD STE 208
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-5721
Practice Address - Country:US
Practice Address - Phone:586-421-1030
Practice Address - Fax:586-421-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0558650002Medicare NSC
MI0558650002Medicare ID - Type Unspecified