Provider Demographics
NPI:1083894349
Name:MARLA J PRICE DO PLLC
Entity Type:Organization
Organization Name:MARLA J PRICE DO PLLC
Other - Org Name:BYRD AND WYANDOTTE EYE CLINIC'
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-284-2444
Mailing Address - Street 1:100 OAK ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-5134
Mailing Address - Country:US
Mailing Address - Phone:734-284-2444
Mailing Address - Fax:735-284-5155
Practice Address - Street 1:100 OAK ST
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-5134
Practice Address - Country:US
Practice Address - Phone:734-284-2444
Practice Address - Fax:735-284-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMP008968207W00000X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMP008968OtherLICENSE
MI2996126Medicaid
MIMP008968OtherLICENSE
MI2996126Medicaid
MIE41356Medicare UPIN