Healthcare Provider Details

I. General information

NPI: 1407803414
Provider Name (Legal Business Name): ASSOCIATED RETINAL CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1179 E PARIS AVE SE 250
GRAND RAPIDS MI
49546-3682
US

IV. Provider business mailing address

2000 N HURON RIVER DR STE 100
YPSILANTI MI
48197-1600
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-2406
  • Fax: 616-942-1165
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALAN JOEL RUBY
Title or Position: OWNER
Credential:
Phone: 248-319-0161