Provider Demographics
NPI:1629301635
Name:SMARCH EYECARE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:SMARCH EYECARE ASSOCIATES, PLLC
Other - Org Name:GRATTAN OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SCHNURER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-625-3500
Mailing Address - Street 1:20 W WASHINGTON ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-1576
Mailing Address - Country:US
Mailing Address - Phone:248-625-3500
Mailing Address - Fax:248-625-0025
Practice Address - Street 1:20 W WASHINGTON ST
Practice Address - Street 2:SUITE 7
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-1576
Practice Address - Country:US
Practice Address - Phone:248-625-3500
Practice Address - Fax:248-625-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004204152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2076Medicare PIN