Provider Demographics
NPI:1336753599
Name:FULL SCOPE EYECARE
Entity Type:Organization
Organization Name:FULL SCOPE EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:D
Authorized Official - Last Name:INGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-793-3131
Mailing Address - Street 1:1221 S ORTONVILLE RD BLDG A
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-8676
Mailing Address - Country:US
Mailing Address - Phone:248-793-3131
Mailing Address - Fax:
Practice Address - Street 1:1221 S ORTONVILLE RD BLDG A
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48462-8676
Practice Address - Country:US
Practice Address - Phone:248-793-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty