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General NPI Number Information
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NPI Number | 1952529588
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Entity Type | Organization
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Legal Business Name | OGAWA MACOMB EYE CENTER, P.C.
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 11/19/2008
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Provider Practice Location Address
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Address Line | 11900 12 MILE ROAD SUITE 206
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City | WARREN
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State | MI
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Zip | 48093
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Country | US
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Telephone | 586-558-5010
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Fax | 586-558-5013
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Provider Business Mailing Address
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Address Line | 11900 12 MILE ROAD SUITE 206
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City | WARREN
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State | MI
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Zip | 48093
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Country | US
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Telephone | 586-558-5010
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Fax | 586-558-5013
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Authorized Official
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Title or Position | MANAGER
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Name | NANCY BARLOG
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Credential |
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Telephone | 586-558-5010
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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 | AO029327
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License Number State | MI
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