Provider Demographics
NPI:1033565213
Name:STONY CREEK EYE CARE PLLC
Entity Type:Organization
Organization Name:STONY CREEK EYE CARE PLLC
Other - Org Name:EXPERTEYES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DORAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-992-3700
Mailing Address - Street 1:8703 26 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-2967
Mailing Address - Country:US
Mailing Address - Phone:586-992-3700
Mailing Address - Fax:586-992-3706
Practice Address - Street 1:8703 26 MILE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-2967
Practice Address - Country:US
Practice Address - Phone:586-992-3700
Practice Address - Fax:586-992-3706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004456152WC0802X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty