Healthcare Provider Details

I. General information

NPI: 1538214119
Provider Name (Legal Business Name): ROCHESTER EYE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 WALTON BLVD
ROCHESTER HILLS MI
48307-6900
US

IV. Provider business mailing address

1282 WALTON BLVD
ROCHESTER HILLS MI
48307-6900
US

V. Phone/Fax

Practice location:
  • Phone: 248-650-2255
  • Fax:
Mailing address:
  • Phone: 248-650-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberMW054440
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMW054440
License Number StateMI

VIII. Authorized Official

Name: DR. MARK D WEINGARTEN
Title or Position: OPHTHALMOLOGIST
Credential: MD
Phone: 248-650-2255