Provider Demographics
NPI:1922303197
Name:ON HEALTHCARE - OPTOMETRY, PLLC
Entity Type:Organization
Organization Name:ON HEALTHCARE - OPTOMETRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:H
Authorized Official - Last Name:LILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-528-1981
Mailing Address - Street 1:100 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 655
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-5206
Mailing Address - Country:US
Mailing Address - Phone:248-528-1981
Mailing Address - Fax:248-528-2183
Practice Address - Street 1:224 HARRISON ST
Practice Address - Street 2:SUITE 218
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3056
Practice Address - Country:US
Practice Address - Phone:248-528-1981
Practice Address - Fax:248-528-2183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007663-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty