Provider Demographics
NPI:1073540324
Name:MICHIGAN GLAUCOMA & CATARACT, P.C.
Entity Type:Organization
Organization Name:MICHIGAN GLAUCOMA & CATARACT, P.C.
Other - Org Name:MICHIGAN GLAUCOMA SPECIALISTS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-218-5457
Mailing Address - Street 1:404 E 10 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLEASANT RIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48069-1201
Mailing Address - Country:US
Mailing Address - Phone:586-218-5457
Mailing Address - Fax:248-220-5261
Practice Address - Street 1:404 E 10 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:PLEASANT RIDGE
Practice Address - State:MI
Practice Address - Zip Code:48069-1201
Practice Address - Country:US
Practice Address - Phone:248-220-5252
Practice Address - Fax:248-220-5261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301405297174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty