Healthcare Provider Details

I. General information

NPI: 1952529588
Provider Name (Legal Business Name): OGAWA MACOMB EYE CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 12 MILE ROAD SUITE 206
WARREN MI
48093
US

IV. Provider business mailing address

11900 12 MILE ROAD SUITE 206
WARREN MI
48093
US

V. Phone/Fax

Practice location:
  • Phone: 586-558-5010
  • Fax: 586-558-5013
Mailing address:
  • Phone: 586-558-5010
  • Fax: 586-558-5013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberAO029327
License Number StateMI

VIII. Authorized Official

Name: NANCY BARLOG
Title or Position: MANAGER
Credential:
Phone: 586-558-5010