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General NPI Number Information
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NPI Number | 1669406641
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Entity Type | Organization
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Legal Business Name | NORTHWEST EYE FOUNDATION
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 6071 W OUTER DR SUITE M-106
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City | DETROIT
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State | MI
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Zip | 48235-2624
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Country | US
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Telephone | 313-966-2024
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Fax | 313-966-7418
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Provider Business Mailing Address
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Address Line | 1560 E. MAPLE RD. SUITE 400-CREDENTIALING
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City | TROY
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State | MI
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Zip | 48083-1189
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Country | US
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Telephone | 248-581-5973
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Fax | 248-581-5640
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MARK S JUZYCH
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Credential | MD
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Telephone | 313-577-8900
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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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