Healthcare Provider Details

I. General information

NPI: 1528061918
Provider Name (Legal Business Name): CATARACT SPECIALTY SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28747 WOODWARD AVE LOWR LEVEL
BERKLEY MI
48072-0931
US

IV. Provider business mailing address

28747 WOODWARD AVE LOWER LEVEL
BERKLEY MI
48072-0914
US

V. Phone/Fax

Practice location:
  • Phone: 248-584-4602
  • Fax: 248-584-4630
Mailing address:
  • Phone: 248-584-4602
  • Fax: 248-584-4630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number636901
License Number StateMI

VIII. Authorized Official

Name: DEBORAH JANKOWSKI
Title or Position: ADMINISTATOR
Credential: BSN, RN
Phone: 248-586-4602