Organization
MAC OPTICAL
Active
Other names
Diamond Optical Care
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DENISE MARIE HENDRICKS (OFFICE ADMINISTRATOR)
(248) 887-4861
Entity
Organization
Contact information
Practice address
1425 N LEROY ST, FENTON, MI 48430-2763
(810) 629-2041
(810) 629-9366
Mailing address
1425 N LEROY ST, FENTON, MI 48430-2763
(810) 629-2041
(810) 629-9366
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003723
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0B51128
BLUE CROSS BLUE SHIELD
MI
01
—
0N11050
HAP
MI
05
—
3442884
—
MI
01
—
900B51128
BLUE CROSS BLUE SHIELD
MI
Enumeration date
10/01/2007
Last updated
03/13/2008
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