Organization
TUDHOPE OPTICAL COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN MARY WIEGAND (OWNER)
(810) 982-0614
Entity
Organization
Contact information
Practice address
2840 PINE GROVE AVE, PORT HURON, MI 48060-1971
(810) 982-0614
(810) 982-0621
Mailing address
2840 PINE GROVE AVE, PORT HURON, MI 48060-1971
(810) 982-0614
(810) 982-0621
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
4901001807
MI
156FX1800X
Optician
—
MI
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0G40268
BCBS OF MI VISION PROV.
MI
01
—
71062
HEALTH PLAN OF MICHIGAN
MI
Enumeration date
03/05/2007
Last updated
11/09/2011
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