Organization
ANN LACROIX FREDAL O.D. PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MONICA SZCZEPANSKI ABOC (OPTICIAN)
(586) 468-4211
Entity
Organization
Contact information
Practice address
136 CASS AVE, MOUNT CLEMENS, MI 48043-2230
(586) 468-4211
(586) 468-6194
Mailing address
136 CASS AVE, MOUNT CLEMENS, MI 48043-2230
(586) 468-4211
(586) 468-6194
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
4901002973
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4007510001
MEDICARE DME
MI
Enumeration date
11/18/2010
Last updated
06/09/2011
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