Provider Demographics
NPI:1114002060
Name:GNB OPTICAL COMPANY
Entity Type:Organization
Organization Name:GNB OPTICAL COMPANY
Other - Org Name:GNB OPTICAL CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZUCKERBROD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-341-3450
Mailing Address - Street 1:43996 WOODWARD AVE SUITE 101
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302
Mailing Address - Country:US
Mailing Address - Phone:248-332-4544
Mailing Address - Fax:248-332-2716
Practice Address - Street 1:43996 WOODWARD AVE SUITE 101
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302
Practice Address - Country:US
Practice Address - Phone:248-332-4544
Practice Address - Fax:248-332-2716
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BURMAN & ZUCKERBROD OPHTHALMOLOGY ASSOC. PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-26
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5047903Medicaid
MI0260780001Medicare NSC