Healthcare Provider Details

I. General information

NPI: 1346230554
Provider Name (Legal Business Name): THE CENTER FOR SIGHT, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 LAURENCE AVE
JACKSON MI
49202-2964
US

IV. Provider business mailing address

1015 LAURENCE AVE
JACKSON MI
49202-2964
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-0364
  • Fax: 517-787-2272
Mailing address:
  • Phone: 517-787-0364
  • Fax: 517-787-2272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003044
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number49010043006
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberAW028076
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMP404850
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMC057919
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301085940
License Number StateMI

VIII. Authorized Official

Name: MARTIN C PATRIAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 517-787-0364