Individual
LIESL A BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
3443 COUNTY LINE RD, CASCO, MI 48064-1000
(586) 727-8000
(586) 727-8004
Mailing address
1921 FRED W MOORE HWY, SAINT CLAIR, MI 48079-4702
(810) 326-3937
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901005440
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619270972
ST CLAIR EYE
MI
01
—
1730264995
ST CLAIR EYE
MI
Enumeration date
05/18/2020
Last updated
05/28/2024
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