Organization
MEDICAL VILLAGE OPTICAL SHOPPE INC
Active
Other names
Medical Village Optical
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROY KNOERR (CEO)
(248) 645-2220
Entity
Organization
Contact information
Practice address
31815 SOUTHFIELD RD, SUITE 12, BEVERLY HILLS, MI 48025-5471
(248) 645-2220
(877) 547-8277
Mailing address
31815 SOUTHFIELD RD, SUITE 12, BEVERLY HILLS, MI 48025-5471
(248) 645-2220
(877) 547-8277
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002468
MI
156FX1800X
Optician
—
—
207W00000X
Ophthalmology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1953840
—
MI
Enumeration date
03/21/2006
Last updated
05/17/2016
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