Healthcare Provider Details

I. General information

NPI: 1558324566
Provider Name (Legal Business Name): HURON OPHTHALMOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 01/10/2023
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5477 W CLARK RD
YPSILANTI MI
48197-1102
US

IV. Provider business mailing address

5477 W CLARK RD
YPSILANTI MI
48197-1102
US

V. Phone/Fax

Practice location:
  • Phone: 734-434-6000
  • Fax: 734-434-7005
Mailing address:
  • Phone: 734-434-6000
  • Fax: 734-434-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY J KATZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 734-434-6000