Organization · NPI-2

Black And White Look Optical Corporation

Optometrist · Southfield, MI

NPI number1679660849
StatusActive
Last updated in NPPESMar 8, 2013

Details

NPI
1679660849
Entity type
Organization (NPI-2)
Legal business name
Black And White Look Optical Corporation
Organization subpart
No
Enumeration date
Oct 6, 2006
Last updated
Mar 8, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
152W00000X Optometrist–MIYes

Practice location

15675 W Ten Mile Rd
Southfield, MI 48075-2188

Phone 248-557-6444 · Fax 248-557-6501

Mailing address

15675 W Ten Mile Rd
Southfield, MI 48075-2188

Phone 248-557-6444 · Fax 248-557-6501

Authorized official

Phyllis Frye
Office Manager
2485576444

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