Healthcare Provider Details

I. General information

NPI: 1518332097
Provider Name (Legal Business Name): MICHIGAN NEURO OPHTHALMOLOGY & OCULOPLASTICS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27450 SCHOENHERR RD STE 200
WARREN MI
48088-6683
US

IV. Provider business mailing address

27450 SCHOENHERR RD STE 200
WARREN MI
48088-6683
US

V. Phone/Fax

Practice location:
  • Phone: 586-582-7859
  • Fax: 586-582-7858
Mailing address:
  • Phone: 586-582-7860
  • Fax: 586-582-7861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. DANIEL J LIN
Title or Position: PARTNER
Credential: MD
Phone: 586-582-7860