Organization
PROFESSIONAL FAMILY EYECARE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER DAVID THEODOROFF O.D. (OPTOMETRIST)
(586) 573-0470
Entity
Organization
Contact information
Practice address
28825 RYAN RD, WARREN, MI 48092-4128
(586) 573-0470
(586) 573-0648
Mailing address
28825 RYAN RD, WARREN, MI 48092-4128
(586) 573-0470
(586) 573-0648
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003333
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900E066750
BCBS MICHIGAN
MI
Enumeration date
12/13/2006
Last updated
05/27/2008
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