1487189254 NPI number — YALDO EYE CENTERS PC

Table of content: (NPI 1487189254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487189254 NPI number — YALDO EYE CENTERS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YALDO EYE CENTERS 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:
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:
1487189254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28501 ORCHARD LAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48334-2951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-553-9800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31535 FORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48135-1821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-278-4540
Provider Business Practice Location Address Fax Number:
313-278-4541
Provider Enumeration Date:
04/28/2017

Additional Information

Authorized Official

Authorized Official Last Name:
YALDO
Authorized Official First Name:
MAZIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
313-278-4540

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  4301051955 , 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)

  • Identifier: 1043221187 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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