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Contact Information

ADRIAN EYE CARE, LLC
580 RIVERSIDE AVE
ADRIAN, MI49221-1543
 Phone: 517-265-6055
 Fax: 517-265-6115
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
 

Eyewear Supplier

332H00000X 87 All Other Suppliers
Indicates primary specialty

NPI Profile & details for ADRIAN EYE CARE, LLC

NPI # 1295807626
LBN Legal business name ADRIAN EYE CARE, LLC
Authorized official PENNY JACKSON - (CREDENTIALING)
Entity Organization
Organization subpart 1 No
Enumeration date 11/14/2006
Last updated 05/08/2026 - About a month ago
Identifiers
MI License # 4901002974
MI License # 4901004286
MI Medicaid 864639178
MI Other 5276880001 DMERC
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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