Provider Demographics
NPI:1992990360
Name:PACK, MICHAEL JAMES (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:PACK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:38979 CHERRY HILL RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-3200
Mailing Address - Country:US
Mailing Address - Phone:734-326-2160
Mailing Address - Fax:734-326-9678
Practice Address - Street 1:38979 CHERRY HILL RD UNIT B
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-3200
Practice Address - Country:US
Practice Address - Phone:734-326-2160
Practice Address - Fax:734-326-9678
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004444152WC0802X, 152WV0400X
MI490100444152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy