Provider Demographics
NPI:1477678514
Name:FAGELMAN EYEWEAR LTD
Entity Type:Organization
Organization Name:FAGELMAN EYEWEAR LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FAGELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-286-6550
Mailing Address - Street 1:39400 GARFIELD RD
Mailing Address - Street 2:102
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4096
Mailing Address - Country:US
Mailing Address - Phone:586-286-6550
Mailing Address - Fax:586-286-1843
Practice Address - Street 1:39400 GARFIELD RD
Practice Address - Street 2:102
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-4096
Practice Address - Country:US
Practice Address - Phone:586-286-6550
Practice Address - Fax:586-286-1843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier