Organization
BLACK AND WHITE LOOK OPTICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PHYLLIS FRYE (OFFICE MANAGER)
(248) 557-6444
Entity
Organization
Contact information
Practice address
15675 W TEN MILE RD, SOUTHFIELD, MI 48075-2188
(248) 557-6444
(248) 557-6501
Mailing address
15675 W TEN MILE RD, SOUTHFIELD, MI 48075-2188
(248) 557-6444
(248) 557-6501
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024599
MIDWEST HEALTH PIN
MI
01
—
0F37859
BLUE CROSS FEDERAL
MI
01
—
113750
TOTAL HEALTH PIN#
MI
01
—
230892
NVA PIN#
MA
05
—
3282118
—
MI
01
—
6719
CO/OP PIN
MI
01
—
900F378590
BLUE CROSS PIN#
MI
Enumeration date
10/06/2006
Last updated
03/08/2013
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