Organization
DISTINCTIVE EYEWEAR, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELIZABETH ANN MOORE CPOT (PRESIDENT)
(810) 329-9725
Entity
Organization
Contact information
Practice address
1280 S 9TH ST, SAINT CLAIR, MI 48079-5368
(810) 329-9725
(810) 329-3491
Mailing address
1280 S 9TH ST, SAINT CLAIR, MI 48079-5368
(810) 329-9725
(810) 329-3491
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002751
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101422
GREAT LAKES HEALTH PLAN
MI
01
—
12065
HEALTH PLAN OF MI
MI
01
—
13314
SPECTERA
MI
01
—
145807
COLE VISION DOCTOR #
MI
01
—
146505
COLE VISION LOCATION #
MI
01
—
25289
NATIONAL VISION ADMIN.
MI
05
—
3020464
—
MI
01
—
900G467000
BLUE CROSS
MI
05
—
943020464
—
MI
01
—
GK490100
BLUE CROSS PIN #
MI
01
—
MI02751
VISION BENEFIT OF AMERICA
MI
01
—
MI2751
EYEMED
MI
Enumeration date
07/04/2006
Last updated
04/10/2015
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