Provider Demographics
NPI:1497876213
Name:THE VILLAGE OPTICIAN
Entity Type:Organization
Organization Name:THE VILLAGE OPTICIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:PARENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-642-2225
Mailing Address - Street 1:725 SOUTH ADAMS ROAD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009
Mailing Address - Country:US
Mailing Address - Phone:248-642-2225
Mailing Address - Fax:248-220-4261
Practice Address - Street 1:725 SOUTH ADAMS ROAD
Practice Address - Street 2:SUITE 125
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009
Practice Address - Country:US
Practice Address - Phone:248-642-2225
Practice Address - Fax:248-220-4261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900F365720OtherBCBS MI