MEDICARE: MACULAR RENEWAL CENTER PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1407716574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MACULAR RENEWAL CENTER PLLC

Provider Business Mailing Address
First Line	:	5300 GATEWAY CTR STE B
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-3930
Country	:	US
Telephone Number	:	810-410-3001
Fax Number	:	810-720-9098

Provider Business Practice Location Address
First Line	:	5300 GATEWAY CTR STE B
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-3930
Country	:	US
Telephone Number	:	810-410-7383
Fax Number	:	810-720-9098

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDWARD PATRICK STACK
Credential	:	MD
Telephone Number	:	810-410-7383

Provider Enumeration Date	:	11/12/2025
Last Update Date	:	04/09/2026

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Directions to “MACULAR RENEWAL CENTER PLLC ” Practice Location

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