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General NPI Number Information
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NPI Number | 1003951575
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Entity Type | Organization
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Legal Business Name | LAKE LAZER EYE CENTER PC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 35776 HARPER AVE
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City | CLINTON TWP
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State | MI
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Zip | 48035-3212
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Country | US
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Telephone | 586-792-3891
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Fax |
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Provider Business Mailing Address
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Address Line | 35776 HARPER AVE
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City | CLINTON TWP
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State | MI
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Zip | 48035-3212
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Country | US
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Telephone | 586-792-3891
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHABBIR KHAMBATI
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Credential | M.D.
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Telephone | 586-792-3891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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