Healthcare Provider Details

I. General information

NPI: 1386671824
Provider Name (Legal Business Name): BALIAN EYE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 W. UNIVERSITY DR.
ROCHESTER MI
48307
US

IV. Provider business mailing address

432 W. UNIVERSITY DR.
ROCHESTER MI
48307
US

V. Phone/Fax

Practice location:
  • Phone: 248-651-6122
  • Fax: 248-651-4825
Mailing address:
  • Phone: 248-651-6122
  • Fax: 248-651-4825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER TEKIELE
Title or Position: CEO
Credential: OD
Phone: 810-853-0409