1316043110 NPI number — DRS. RAVIN, BIRNDORF & RAVIN, INC.

Table of content: (NPI 1316043110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316043110 NPI number — DRS. RAVIN, BIRNDORF & RAVIN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS. RAVIN, BIRNDORF & RAVIN, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SPECIALTY EYE INSTITUTE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316043110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 W NORTH ST STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49202-3196
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-852-8463
Provider Business Mailing Address Fax Number:
517-817-0144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 REGENCY CT STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43623-3081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-882-2020
Provider Business Practice Location Address Fax Number:
419-885-8440
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROARK
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
517-841-3007

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207WX0107X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 900D610840 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: CA0110 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DE0364 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 180D661670 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0630320 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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