Provider Demographics
NPI:1063544799
Name:FOURMILE EYE CARE, LLC
Entity type:Organization
Organization Name:FOURMILE EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEDDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-485-4306
Mailing Address - Street 1:10223 E AVONDALE CIR
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48198-2600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35000 WARREN RD
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-6223
Practice Address - Country:US
Practice Address - Phone:734-425-1190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004194152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P15680Medicare ID - Type Unspecified