MEDICARE: LASIK CENTERS OF MICHIGAN PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS0132X	Ophthalmologic Surgery Clinic/Center	DF058932	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1808245461	OTHER	MI	BCBS MI

General Provider Information

NPI Number	:	1114138781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LASIK CENTERS OF MICHIGAN PC

Provider Business Mailing Address
First Line	:	25325 FORD RD
Second Line	:	SUITE 200
City	:	DEARBORN
State	:	MI
Zip	:	48128-1086
Country	:	US
Telephone Number	:	313-357-3006
Fax Number	:	313-724-2455

Provider Business Practice Location Address
First Line	:	25325 FORD RD
Second Line	:	SUITE 200
City	:	DEARBORN
State	:	MI
Zip	:	48128-1086
Country	:	US
Telephone Number	:	313-357-3006
Fax Number	:	313-724-2455

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONALD C FIANDER
Credential	:	MD
Telephone Number	:	313-357-3006

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	08/22/2020

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