Provider Demographics
NPI:1417194580
Name:SOPHA OPTICIANS, PLLC
Entity Type:Organization
Organization Name:SOPHA OPTICIANS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOPHA
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:586-336-4566
Mailing Address - Street 1:64207 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48095-2579
Mailing Address - Country:US
Mailing Address - Phone:586-336-4566
Mailing Address - Fax:586-336-4702
Practice Address - Street 1:64207 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48095-2579
Practice Address - Country:US
Practice Address - Phone:586-336-4566
Practice Address - Fax:586-336-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI166899332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6158860001Medicare NSC