Provider Demographics
NPI:1730235813
Name:EYEWARE UNLIMITED INC
Entity type:Organization
Organization Name:EYEWARE UNLIMITED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:SARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-559-0930
Mailing Address - Street 1:17090 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2137
Mailing Address - Country:US
Mailing Address - Phone:248-559-0930
Mailing Address - Fax:248-559-0939
Practice Address - Street 1:17090 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2137
Practice Address - Country:US
Practice Address - Phone:248-559-0930
Practice Address - Fax:248-559-0939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF36775OtherBC BS OF MICHIGAN
MI0204980001Medicare ID - Type Unspecified