Provider Demographics
NPI:1215136353
Name:NORTHVILLE VISION CLINIC PC
Entity type:Organization
Organization Name:NORTHVILLE VISION CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ADELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-348-1330
Mailing Address - Street 1:42000 6 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-4379
Mailing Address - Country:US
Mailing Address - Phone:248-348-1330
Mailing Address - Fax:248-348-7107
Practice Address - Street 1:42000 6 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-4379
Practice Address - Country:US
Practice Address - Phone:248-348-1330
Practice Address - Fax:248-348-7107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2022-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN80720001Medicare UPIN
MI0154750001Medicare NSC