Provider Demographics
NPI:1578097259
Name:EYECARE OF LIVONIA PLLC
Entity Type:Organization
Organization Name:EYECARE OF LIVONIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KIEFIUK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:249-249-4793
Mailing Address - Street 1:5016 WAVEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-1362
Mailing Address - Country:US
Mailing Address - Phone:249-249-4793
Mailing Address - Fax:
Practice Address - Street 1:13700 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2215
Practice Address - Country:US
Practice Address - Phone:734-427-2944
Practice Address - Fax:734-853-3798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU80901Medicare UPIN