Organization
WILLIAM BEAUMONT HOSPTIAL
Active
Other names
BEAUMONT OPTICAL SHOP
Organization subpart
No
Provider details
NPI number
Authorized official
LEE ANN ODOM (PRESIDENT SHARED SERVICES)
(947) 522-3326
Entity
Organization
Contact information
Practice address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(248) 423-2454
(248) 423-2576
Mailing address
26901 BEAUMONT BLVD, COMPLIANCE, SOUTHFIELD, MI 48033-3849
(947) 522-1964
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900F374910
BCBSM
MI
Enumeration date
05/14/2007
Last updated
10/01/2021
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