Organization
MAC OPTICAL
Active
Other names
Diamond Optical Care
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL G HENDRICKS (OWNER)
(810) 629-2041
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
(810) 664-5929
(810) 664-4915
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
MH003723
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0D41012
BLUE CROSS BLUE SHIELD
MI
01
—
0N11050
HAP
MI
05
—
3442900
—
MI
01
—
900D41012
BLUE CROSS BLUE SHIELD
MI
05
—
943442900
—
MI
Enumeration date
03/14/2007
Last updated
02/09/2011
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