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General NPI Number Information
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NPI Number | 1457007379
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Entity Type | Organization
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Legal Business Name | MICHIGAN OPHTHALMOLOGY SPECIALISTS, PLLC
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Dates
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Enumeration Date | 03/01/2022
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 330 E 14 MILE RD STE B
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City | CLAWSON
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State | MI
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Zip | 48017-2118
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Country | US
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Telephone | 248-589-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 30150 TELEGRAPH RD STE 271
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City | BINGHAM FARMS
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State | MI
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Zip | 48025-4521
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Country | US
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Telephone | 248-395-5175
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | BEVERLY ZWICKER
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Credential |
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Telephone | 248-395-5175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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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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