1407981343 NPI number — EYE CARE PROVIDERS OF MICHIGAN PC

Table of content: (NPI 1407981343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407981343 NPI number — EYE CARE PROVIDERS OF MICHIGAN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE CARE PROVIDERS OF MICHIGAN PC
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:
Provider Other Organization Name Type Code:
6
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:
1407981343
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26010
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRASER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48026-6010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-296-7250
Provider Business Mailing Address Fax Number:
586-296-0276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33080 UTICA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRASER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48026-2038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-296-7250
Provider Business Practice Location Address Fax Number:
586-296-0276
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CZAJKOWSKI
Authorized Official First Name:
NORBERT
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER DIRECTOR
Authorized Official Telephone Number:
586-296-7250

Provider Taxonomy Codes

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

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





Copyright © 2007-2025 www.npivalidator.com