Organization
LAKEVILLE EYE CARE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERESA MARIE ENNIS-DECKER O.D. (OWNER)
(989) 871-9552
Entity
Organization
Contact information
Practice address
9575 STATE RD, MILLINGTON, MI 48746-9482
(989) 871-9552
(989) 871-9554
Mailing address
9575 STATE RD, MILLINGTON, MI 48746-9482
(989) 871-9552
(989) 871-9554
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
944743819
—
MI
Enumeration date
06/13/2006
Last updated
01/17/2013
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