1447557764 NPI number — CHESTERFIELD EYE CARE P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447557764 NPI number — CHESTERFIELD EYE CARE P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESTERFIELD EYE CARE P.C.
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:
1447557764
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8703 26 MILE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48094-2967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-992-3700
Provider Business Mailing Address Fax Number:
586-992-3706

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27903 23 MILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48051-2328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-598-3937
Provider Business Practice Location Address Fax Number:
586-598-3941
Provider Enumeration Date:
02/23/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WEISGERBER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
586-598-3937

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WS0006X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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