Provider Demographics
NPI:1609991033
Name:EYE REFRACTORY
Entity Type:Organization
Organization Name:EYE REFRACTORY
Other - Org Name:KAY HARRIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-743-3155
Mailing Address - Street 1:1348 E BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-2212
Mailing Address - Country:US
Mailing Address - Phone:810-743-3155
Mailing Address - Fax:810-743-7127
Practice Address - Street 1:1348 E BRISTOL RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529-2212
Practice Address - Country:US
Practice Address - Phone:810-743-3155
Practice Address - Fax:810-743-7127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2777406Medicaid