Provider Demographics
NPI:1447426705
Name:PCOR - LLC
Entity Type:Organization
Organization Name:PCOR - LLC
Other - Org Name:HENRY FORD OPTIMEYES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-577-3624
Mailing Address - Street 1:655 W 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1850
Mailing Address - Country:US
Mailing Address - Phone:248-577-3616
Mailing Address - Fax:248-307-9518
Practice Address - Street 1:29351 JOHN R RD
Practice Address - Street 2:
Practice Address - City:MADISON HTS
Practice Address - State:MI
Practice Address - Zip Code:48071-5405
Practice Address - Country:US
Practice Address - Phone:248-544-3290
Practice Address - Fax:248-307-9518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1141070013Medicare NSC