Provider Demographics
NPI:1942212550
Name:OAKLAND OPTOMETRY, P.C.
Entity Type:Organization
Organization Name:OAKLAND OPTOMETRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-373-6500
Mailing Address - Street 1:4970 N ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-1416
Mailing Address - Country:US
Mailing Address - Phone:248-373-6500
Mailing Address - Fax:248-373-6555
Practice Address - Street 1:4970 N ADAMS RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48306-1416
Practice Address - Country:US
Practice Address - Phone:248-373-6500
Practice Address - Fax:248-373-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003127152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU37068Medicare UPIN
MIOP24920Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER