Healthcare Provider Details

I. General information

NPI: 1922131259
Provider Name (Legal Business Name): LIVONIA OPHTHALMOLOGISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29927 6 MILE RD
LIVONIA MI
48152-3670
US

IV. Provider business mailing address

29927 6 MILE RD
LIVONIA MI
48152-3670
US

V. Phone/Fax

Practice location:
  • Phone: 734-522-0800
  • Fax: 734-522-1236
Mailing address:
  • Phone: 734-522-0800
  • Fax: 734-522-1236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JEFFREY R LUPOVITCH
Title or Position: DIRECTOR OFFICER
Credential: M.D.
Phone: 734-522-0800