Organization
C & C OPTICAL SHOP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHERRY MARIE WALTON (MANAGER)
(231) 924-1988
Entity
Organization
Contact information
Practice address
1007 W MAIN ST, FREMONT, MI 49412-1420
(231) 924-1988
(231) 924-1622
Mailing address
1007 W MAIN ST, FREMONT, MI 49412-1420
(231) 924-1988
(231) 924-1622
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
1262670001
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3455345
—
MI
Enumeration date
08/23/2006
Last updated
01/10/2008
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