Healthcare Provider Details

I. General information

NPI: 1114138781
Provider Name (Legal Business Name): LASIK CENTERS OF MICHIGAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25325 FORD RD SUITE 200
DEARBORN MI
48128-1086
US

IV. Provider business mailing address

25325 FORD RD SUITE 200
DEARBORN MI
48128-1086
US

V. Phone/Fax

Practice location:
  • Phone: 313-357-3006
  • Fax: 313-724-2455
Mailing address:
  • Phone: 313-357-3006
  • Fax: 313-724-2455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License NumberDF058932
License Number StateMI

VIII. Authorized Official

Name: DR. DONALD C FIANDER
Title or Position: PRESIDENT
Credential: MD
Phone: 313-357-3006