Provider Demographics
NPI:1891201406
Name:SHARPER VISION PC
Entity Type:Organization
Organization Name:SHARPER VISION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS-BLAKEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:313-974-7299
Mailing Address - Street 1:71 GARFIELD ST APT 180
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1911
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:71 GARFIELD ST APT 180
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1911
Practice Address - Country:US
Practice Address - Phone:313-974-7299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1639217722OtherINDIVIDUAL NPI