Provider Demographics
NPI:1689722852
Name:LAURENCE OPTICAL CO., INC.
Entity Type:Organization
Organization Name:LAURENCE OPTICAL CO., INC.
Other - Org Name:DOC MEADOWBROOK AT SPRINGHILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:SPICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-375-0022
Mailing Address - Street 1:2915 WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1419
Mailing Address - Country:US
Mailing Address - Phone:248-375-0022
Mailing Address - Fax:
Practice Address - Street 1:2915 WALTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1419
Practice Address - Country:US
Practice Address - Phone:248-375-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2672490100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty