Basic Information
| Provider Information | |||||||||
| NPI: | 1497340095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POUNCY | ||||||||
| FirstName: | DORION | ||||||||
| MiddleName: | KEITH | ||||||||
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| NameSuffix: | SR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19853 OUTER DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481242044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134065056 | ||||||||
| FaxNumber: | 2487124381 | ||||||||
| Practice Location | |||||||||
| Address1: | 19853 OUTER DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481242044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134065056 | ||||||||
| FaxNumber: | 2487124381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2021 | ||||||||
| LastUpdateDate: | 03/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156F00000X | MI | Y | Eye and Vision Services Providers | Technician/Technologist | 106S00000X | MI | N |
No ID Information.