=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598703639
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAHMANI EYE INSTITUTE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2006
-----------------------------------------------------
Last Update Date | 06/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19727 ALLEN ROAD SUITE 11
-----------------------------------------------------
City | BROWNSTONE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-479-4747
-----------------------------------------------------
Fax | 734-479-4774
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19727 ALLEN ROAD SUITE 11
-----------------------------------------------------
City | BROWNSTONE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-479-4747
-----------------------------------------------------
Fax | 734-479-4774
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL BILLER
-----------------------------------------------------
Name | KANDI BOCK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 734-479-4747
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | RR011221
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------