Healthcare Provider Details

I. General information

NPI: 1114176500
Provider Name (Legal Business Name): TAKAHASHI EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 02/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 W EISENHOWER CIR SUITE F
ANN ARBOR MI
48103-5868
US

IV. Provider business mailing address

955 W EISENHOWER CIR SUITE F
ANN ARBOR MI
48103-5868
US

V. Phone/Fax

Practice location:
  • Phone: 734-332-8840
  • Fax:
Mailing address:
  • Phone: 734-332-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number4901003036
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4901003036
License Number StateMI

VIII. Authorized Official

Name: DR. JOYCE K TAKAHASHI
Title or Position: PRESIDENT
Credential: OD
Phone: 734-332-8840