Healthcare Provider Details

I. General information

NPI: 1245490242
Provider Name (Legal Business Name): CHILDREN'S EYE CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 ORCHARD LAKE ROAD SUITE 200
WEST BLOOMFIELD MI
48322
US

IV. Provider business mailing address

6689 ORCHARD LAKE ROAD #297
WEST BLOOMFIELD MI
48322
US

V. Phone/Fax

Practice location:
  • Phone: 248-538-7400
  • Fax: 248-538-7403
Mailing address:
  • Phone: 248-254-8140
  • Fax: 248-254-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY SOKOL
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 248-254-8140