Healthcare Provider Details

I. General information

NPI: 1841462181
Provider Name (Legal Business Name): INSIGHT OPHTHALMOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29927 SIX MILE ROAD
LIVONIA MI
48152
US

IV. Provider business mailing address

7189 COTTONWOOD KNOLL
WEST BLOOMFIELD MI
48322
US

V. Phone/Fax

Practice location:
  • Phone: 734-522-0002
  • Fax: 734-522-0007
Mailing address:
  • Phone: 734-522-0002
  • Fax: 734-522-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301079764
License Number StateMI

VIII. Authorized Official

Name: DR. JEFFREY R LUPOVITCH
Title or Position: OWNER
Credential: MD
Phone: 248-535-0007