Provider Demographics
NPI:1689014573
Name:EYE 2 EYE CONTACT
Entity Type:Organization
Organization Name:EYE 2 EYE CONTACT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:DARE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC,NCLEC,MBOC
Authorized Official - Phone:313-378-7883
Mailing Address - Street 1:723 RIVER PARK VILLAGE BLVD
Mailing Address - Street 2:MOBILE UNIT DISPENSARY
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2777
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:723 RIVER PARK VILLAGE BLVD
Practice Address - Street 2:MOBILE UNIT DISPENSARY
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2777
Practice Address - Country:US
Practice Address - Phone:313-378-7883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI151016156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty