Provider Demographics
NPI:1700912433
Name:IMLAY CITY OPTICAL INC
Entity Type:Organization
Organization Name:IMLAY CITY OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:F
Authorized Official - Last Name:WHALEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:810-724-6155
Mailing Address - Street 1:125 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:IMLAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48444-1029
Mailing Address - Country:US
Mailing Address - Phone:810-724-6155
Mailing Address - Fax:810-724-7708
Practice Address - Street 1:125 W 3RD ST
Practice Address - Street 2:
Practice Address - City:IMLAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48444-1029
Practice Address - Country:US
Practice Address - Phone:810-724-6155
Practice Address - Fax:810-724-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003127Medicaid
MIOD47605OtherBCBS