Provider Demographics
NPI:1184252165
Name:CAPSTONE VISION, PLLC
Entity type:Organization
Organization Name:CAPSTONE VISION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EMMERT-BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:248-710-0063
Mailing Address - Street 1:691 N SQUIRREL RD STE 202
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2871
Mailing Address - Country:US
Mailing Address - Phone:248-710-0063
Mailing Address - Fax:248-710-0056
Practice Address - Street 1:691 N SQUIRREL RD STE 202
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2871
Practice Address - Country:US
Practice Address - Phone:248-710-0063
Practice Address - Fax:240-710-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty