Provider Demographics
NPI:1750491213
Name:OKEMOS OPTOMETRY,PC
Entity type:Organization
Organization Name:OKEMOS OPTOMETRY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:SHERMAN
Authorized Official - Last Name:SILVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-349-8888
Mailing Address - Street 1:2080 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2105
Mailing Address - Country:US
Mailing Address - Phone:517-349-8888
Mailing Address - Fax:517-349-1788
Practice Address - Street 1:2080 HAMILTON RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2105
Practice Address - Country:US
Practice Address - Phone:517-349-8888
Practice Address - Fax:517-349-1788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003031152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2939273Medicaid
MI2939273Medicaid
MI0P18550Medicare ID - Type Unspecified