Provider Demographics
NPI:1003154014
Name:SWITCH EYE CENTER, P.C.
Entity Type:Organization
Organization Name:SWITCH EYE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:SWITCH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:313-295-3937
Mailing Address - Street 1:8950 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-8399
Mailing Address - Country:US
Mailing Address - Phone:313-295-3937
Mailing Address - Fax:313-295-2006
Practice Address - Street 1:1218 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-5516
Practice Address - Country:US
Practice Address - Phone:313-295-3937
Practice Address - Fax:313-295-2006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SWITCH EYE CENTER, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009244207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1423Medicare PIN
MIE41357Medicare UPIN