Healthcare Provider Details

I. General information

NPI: 1326238395
Provider Name (Legal Business Name): MILLMAN-DERR CENTER FOR EYE CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 BARCLAY CIR
ROCHESTER HILLS MI
48307-4511
US

IV. Provider business mailing address

PO BOX 80070
ROCHESTER MI
48308-0070
US

V. Phone/Fax

Practice location:
  • Phone: 248-852-3636
  • Fax: 248-852-3631
Mailing address:
  • Phone: 248-852-3636
  • Fax: 248-852-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DAVID BOBERG
Title or Position: ADMINISTRATOR
Credential:
Phone: 248-852-3636