Organization
PROFESSIONAL OPTICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID DZIAK (MEMBER)
(231) 487-0171
Entity
Organization
Contact information
Practice address
560 W MITCHELL ST, SUITE#204, PETOSKEY, MI 49770-2275
(231) 487-0171
Mailing address
560 W MITCHELL ST, SUITE#204, PETOSKEY, MI 49770-2275
(231) 487-0171
(231) 487-0690
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
540B411030
MI BCBS
MI
Enumeration date
12/13/2006
Last updated
07/17/2008
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