Healthcare Provider Details

I. General information

NPI: 1972874683
Provider Name (Legal Business Name): CHILDREN'S EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

IV. Provider business mailing address

6689 ORCHARD LAKE ROAD #297
WEST BLOOMFIELD MI
48322-3009
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-3937
  • Fax: 313-745-0401
Mailing address:
  • Phone: 248-254-8140
  • Fax: 248-254-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACI FRITZ
Title or Position: PRACTICE MANAGER
Credential:
Phone: 248-254-8140