Organization
PROFESSIONAL CONTACT LENS CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUDOLPH SAM DEMERCURIO O.D. (PRESIDENT)
(248) 737-3937
Entity
Organization
Contact information
Practice address
30660 W 12 MILE RD, FARMINGTON HILLS, FARMINGTON HILLS, MI 48334-3808
(248) 737-3937
(248) 737-2816
Mailing address
30660 W 12 MILE RD, FARMINGTON HILLS, FARMINGTON HILLS, MI 48334-3808
(248) 737-3937
(248) 737-2816
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2356
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MI4432
MEDICARE PTAN
MI
Enumeration date
02/20/2007
Last updated
01/06/2012
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