Individual
LEIGH SHORES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3923 PINE GROVE ROAD, FORT GRATIOT, MI 48059-4251
(810) 985-3333
(810) 989-9279
Mailing address
3923 PINE GROVE ROAD, FORT GRATIOT, MI 48059-4251
(810) 985-3333
(810) 989-9279
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003150
MI
Other
Enumeration date
10/11/2006
Last updated
07/08/2007
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