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General NPI Number Information
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NPI Number | 1164599437
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Entity Type | Organization
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Legal Business Name | ADVANCED EYE CARE MD PC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 23077 GREENFIELD SUITE 144
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3738
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Country | US
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Telephone | 248-569-6120
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Fax |
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Provider Business Mailing Address
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Address Line | 23077 GREENFIELD SUITE 144
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3738
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Country | US
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Telephone | 248-569-6120
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LANNY GREEN
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Credential | M.D
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Telephone | 248-569-6120
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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 | LG077362
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License Number State | MI
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