P-Cor, LLC
Organization Active NPI Optometrist · Southfield, MI
NPI 1154954741 · NPPES record last updated Feb 21, 2020
Key facts
- NPI
- 1154954741
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- P-COR, LLC
- Practice address
- 29350 Southfield Rd Ste 150
Southfield, MI 48076-2011 - Phone
- (248) 647-9790
- NPI assigned
- Feb 21, 2020
- Organization subpart
- No
Authorized official
- Name
- Shakia Tisdale
- Title
- Credentialing/Privileging
- Phone
- (248) 577-3659
Corporate family (same tax ID) 25
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| P-Cor LLC |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses | Accepts assignment |
National Provider Directory
- Tax ID family
- P-Cor LLC
Locations
29350 Southfield Rd
Ste 150
Southfield, MI 48076
Phone (248) 647-9790
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
29350 Southfield Rd Ste 150
Southfield, MI 48076-2011
Mailing address
735 John R Rd Ste 150
Troy, MI 48083-5859
Phone (248) 588-9300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720033343 | Medicaid | MI |
Other names
- Advanced Eye Care Clinic
Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.