Organization
CUSTOM EYE PROSTHETICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY ALLEN BULGARELLI SR. BCO BADO BOARD CERTI (OWNER)
(586) 755-6900
Entity
Organization
Contact information
Practice address
27600 HOOVER RD, WARREN, MI 48093-7721
(586) 755-6900
(586) 755-8026
Mailing address
27600 HOOVER RD, WARREN, MI 48093-7721
(586) 755-6900
(586) 755-8026
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
Primary
5001000012
MI
Other
Enumeration date
11/28/2006
Last updated
08/22/2020
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