Individual
MARK A LAVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
354 W 14 MILE RD, OAKLAND MALL, TROY, MI 48083-4218
(248) 585-0044
(248) 585-5525
Mailing address
5448 VAN NESS DR, BLOOMFIELD HILLS, MI 48302-2670
(248) 857-2353
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002664
MI
Other
Enumeration date
12/12/2006
Last updated
05/26/2010
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