Provider Demographics
NPI:1336823111
Name:CALDWELL, WILLIE MOSEORRIE JR
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:MOSEORRIE
Last Name:CALDWELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33464 SCHOENHERR RD STE 180
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-6392
Mailing Address - Country:US
Mailing Address - Phone:313-543-4367
Mailing Address - Fax:
Practice Address - Street 1:33464 SCHOENHERR RD STE 180
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-6392
Practice Address - Country:US
Practice Address - Phone:313-543-4367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist