Provider Demographics
NPI:1851169650
Name:UNIQUELY SPECIAL OPTICAL LLC
Entity Type:Organization
Organization Name:UNIQUELY SPECIAL OPTICAL LLC
Other - Org Name:UNIQUELY SPECIAL OPTICAL LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EYECARE PROFESSIONAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:248-818-6702
Mailing Address - Street 1:24554 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1031
Mailing Address - Country:US
Mailing Address - Phone:248-818-6702
Mailing Address - Fax:
Practice Address - Street 1:24554 GROVE AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1031
Practice Address - Country:US
Practice Address - Phone:248-818-6702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty