Organization
P-COR, LLC
Active
Other names
Advanced Eye Care Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SHAKIA TISDALE (CREDENTIALING/PRIVILEGING)
(248) 577-3659
Entity
Organization
Contact information
Practice address
29350 SOUTHFIELD RD STE 150, SOUTHFIELD, MI 48076-2011
(248) 647-9790
Mailing address
735 JOHN R RD STE 150, TROY, MI 48083-5859
(248) 588-9300
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720033343
—
MI
Enumeration date
02/21/2020
Last updated
02/21/2020
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