Provider Demographics
NPI:1922371665
Name:SHARPER VISION, PLLC
Entity Type:Organization
Organization Name:SHARPER VISION, PLLC
Other - Org Name:SHARPER VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:I
Authorized Official - Last Name:BLAKEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:734-927-9963
Mailing Address - Street 1:1675 N. CANTON CENTER RD.
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187
Mailing Address - Country:US
Mailing Address - Phone:734-927-9963
Mailing Address - Fax:734-927-9966
Practice Address - Street 1:1675 N. CANTON CENTER RD.
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187
Practice Address - Country:US
Practice Address - Phone:734-927-9963
Practice Address - Fax:734-927-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI49010037855152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5674Medicare PIN