Provider Demographics
NPI:1295861789
Name:CENTER VISIONS OPTICAL
Entity Type:Organization
Organization Name:CENTER VISIONS OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-682-6448
Mailing Address - Street 1:2544 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SYLVAN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48320-1536
Mailing Address - Country:US
Mailing Address - Phone:248-682-6448
Mailing Address - Fax:248-682-3398
Practice Address - Street 1:2544 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:SYLVAN LAKE
Practice Address - State:MI
Practice Address - Zip Code:48320-1536
Practice Address - Country:US
Practice Address - Phone:248-682-6448
Practice Address - Fax:248-682-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003848152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty