Organization
P-COR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GAIL A. ELIAS (VP)
(248) 577-3624
Entity
Organization
Contact information
Practice address
504 N TELEGRAPH RD, MONROE, MI 48162
(734) 243-2020
(734) 243-4567
Mailing address
735 JOHN R RD STE 150, TROY, MI 48083-5859
(248) 588-9300
(734) 243-4567
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003915
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03420
PARAMOUNT
MI
01
—
230629
NVA
MI
01
—
38866
DAVIS VISION
MI
05
—
4093447
—
MI
01
—
900E810860
BLUE CROSS BLUE SHIELD
MI
01
—
MI3915
EYEMED
MI
Enumeration date
09/06/2007
Last updated
01/22/2018
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