Provider Demographics
NPI:1013122639
Name:DOCTORS ALVARADO, P.C.
Entity Type:Organization
Organization Name:DOCTORS ALVARADO, P.C.
Other - Org Name:FENTON VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-629-3070
Mailing Address - Street 1:1535 N LEROY ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2791
Mailing Address - Country:US
Mailing Address - Phone:810-629-3070
Mailing Address - Fax:
Practice Address - Street 1:1535 N LEROY ST
Practice Address - Street 2:SUITE D
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2791
Practice Address - Country:US
Practice Address - Phone:810-629-3070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003993152W00000X
MI4901002996152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1689754350OtherNPI
MI1366523086OtherNPI
MIN35320001Medicare ID - Type UnspecifiedJUAN ALVARADO
MIU82380Medicare UPIN
MI1689754350OtherNPI
MIN35320003Medicare ID - Type UnspecifiedCYNTHIA CUPAL
MI1366523086OtherNPI