Healthcare Provider Details

I. General information

NPI: 1659516748
Provider Name (Legal Business Name): GROSSE POINTE EYE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20845 MACK AVE
GROSSE POINTE MI
48236-1456
US

IV. Provider business mailing address

20845 MACK AVE
GROSSE POINTE MI
48236-1456
US

V. Phone/Fax

Practice location:
  • Phone: 313-885-4987
  • Fax:
Mailing address:
  • Phone: 313-885-4987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberPV033783
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPV033783
License Number StateMI

VIII. Authorized Official

Name: DR. PATRICK M VERB
Title or Position: DIRECTOR
Credential: M.D.
Phone: 313-885-4987