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General NPI Number Information
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NPI Number | 1740464775
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Entity Type | Organization
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Legal Business Name | SOUTHLAND EYE CLINIC, P.C.
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 15055 S PLAZA DR
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City | TAYLOR
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State | MI
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Zip | 48180-5202
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Country | US
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Telephone | 734-287-2666
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Fax | 734-287-3864
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Provider Business Mailing Address
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Address Line | 15055 S PLAZA DR
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City | TAYLOR
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State | MI
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Zip | 48180-5202
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Country | US
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Telephone | 734-287-2666
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Fax | 734-287-3864
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | DR. MARILYN K. BELAMARIC
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Credential | M.D.
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Telephone | 734-287-2666
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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 | 4301034114
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License Number State | MI
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