Organization
GRAND BLANC EYES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW JOHN AGNONE O.D. (OWNER/MEMBER)
(810) 694-3937
Entity
Organization
Contact information
Practice address
11225 S SAGINAW ST, GRAND BLANC, MI 48439-1285
(810) 694-3937
(810) 694-9876
Mailing address
11225 S SAGINAW ST, SUITE 10, GRAND BLANC, MI 48439-1285
(810) 694-3937
(810) 694-9876
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0995464
HEALTHPLUS OF MICHIGAN
MI
01
—
900B511570
BLUE CROSS BLUE SHIELD
MI
Enumeration date
09/28/2006
Last updated
02/25/2022
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