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General NPI Number Information
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NPI Number | 1639781545
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Entity Type | Organization
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Legal Business Name | HARBOR RETINA CENTER PLLC
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 3273 DAVISON RD STE 1
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City | LAPEER
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State | MI
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Zip | 48446-2902
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Country | US
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Telephone | 810-356-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 3273 DAVISON RD STE 1
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City | LAPEER
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State | MI
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Zip | 48446-2902
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Country | US
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Telephone | 810-356-9700
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Fax | 810-356-9700
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DEEPAK MANGLA
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Credential |
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Telephone | 810-356-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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