Provider Demographics
NPI:1093960858
Name:GROSSE POINTE EYE CENTER
Entity Type:Organization
Organization Name:GROSSE POINTE EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:VERB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-885-4987
Mailing Address - Street 1:20845 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1456
Mailing Address - Country:US
Mailing Address - Phone:313-885-4987
Mailing Address - Fax:313-885-4198
Practice Address - Street 1:20845 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1456
Practice Address - Country:US
Practice Address - Phone:313-885-4987
Practice Address - Fax:313-885-4198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPV033783332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0713380001Medicare NSC