Provider Demographics
NPI:1609223619
Name:JUAN ALVARADO OD PLLC
Entity Type:Organization
Organization Name:JUAN ALVARADO OD PLLC
Other - Org Name:FENTON EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-252-9926
Mailing Address - Street 1:PO BOX 765
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-0765
Mailing Address - Country:US
Mailing Address - Phone:810-252-9926
Mailing Address - Fax:810-629-6748
Practice Address - Street 1:212 W SILVER LAKE RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2606
Practice Address - Country:US
Practice Address - Phone:810-629-3070
Practice Address - Fax:810-629-6748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty