Provider Demographics
NPI:1831438746
Name:OPTOMETRY, P.C.
Entity type:Organization
Organization Name:OPTOMETRY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:586-263-9708
Mailing Address - Street 1:42550 GARFIELD RD
Mailing Address - Street 2:STE. 101
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1644
Mailing Address - Country:US
Mailing Address - Phone:586-263-9708
Mailing Address - Fax:586-263-0280
Practice Address - Street 1:57970 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48094-2883
Practice Address - Country:US
Practice Address - Phone:586-677-6384
Practice Address - Fax:586-677-9256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003900152W00000X
MI4901003953152W00000X
MI4901003968152W00000X
MI4901003988152W00000X
MI4901002754152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E06315Medicare PIN