Provider Demographics
NPI:1689716490
Name:METRO VISION II,INC
Entity Type:Organization
Organization Name:METRO VISION II,INC
Other - Org Name:METRO VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LICAVOLI
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:586-286-7200
Mailing Address - Street 1:39087 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-2789
Mailing Address - Country:US
Mailing Address - Phone:586-286-7200
Mailing Address - Fax:586-286-4144
Practice Address - Street 1:39087 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-2789
Practice Address - Country:US
Practice Address - Phone:586-286-7200
Practice Address - Fax:586-286-4144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1064680001Medicare ID - Type UnspecifiedMEDICARE
MI900E0768100Medicare UPIN