Provider Demographics
NPI:1003082447
Name:MANCHESTER EYE CARE CENTER, P.C.
Entity Type:Organization
Organization Name:MANCHESTER EYE CARE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MARVIN-MANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:734-428-2020
Mailing Address - Street 1:110 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48158-9776
Mailing Address - Country:US
Mailing Address - Phone:734-428-2020
Mailing Address - Fax:734-428-8955
Practice Address - Street 1:110 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48158-9776
Practice Address - Country:US
Practice Address - Phone:734-428-2020
Practice Address - Fax:734-428-8955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003224261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT96957Medicare UPIN