Provider Demographics
NPI:1295864759
Name:VILLAGE OPTICAL INC
Entity Type:Organization
Organization Name:VILLAGE OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:313-885-5400
Mailing Address - Street 1:19992 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1622
Mailing Address - Country:US
Mailing Address - Phone:313-885-1733
Mailing Address - Fax:
Practice Address - Street 1:16841 KERCHEVAL PL
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1553
Practice Address - Country:US
Practice Address - Phone:313-885-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL907492152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900H241570OtherBCBSM
MI0N92330Medicare PIN