Provider Demographics
NPI:1447799853
Name:OPTICAL MANAGEMENT SERVICES, LLC
Entity Type:Organization
Organization Name:OPTICAL MANAGEMENT SERVICES, LLC
Other - Org Name:RIVERFRONT EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DELEGATED OFFICIAL/CREDENTIALING SP
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-790-5005
Mailing Address - Street 1:31503 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4583
Mailing Address - Country:US
Mailing Address - Phone:586-343-0015
Mailing Address - Fax:586-238-2136
Practice Address - Street 1:31503 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4583
Practice Address - Country:US
Practice Address - Phone:586-343-0015
Practice Address - Fax:586-238-2136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIE5186F152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty