Provider Demographics
NPI:1114138781
Name:LASIK CENTERS OF MICHIGAN PC
Entity Type:Organization
Organization Name:LASIK CENTERS OF MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:FIANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-357-3006
Mailing Address - Street 1:25325 FORD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1086
Mailing Address - Country:US
Mailing Address - Phone:313-357-3006
Mailing Address - Fax:313-724-2455
Practice Address - Street 1:25325 FORD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1086
Practice Address - Country:US
Practice Address - Phone:313-357-3006
Practice Address - Fax:313-724-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDF058932261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1808245461OtherBCBS MI
MI1808245461OtherBCBS MI
MIF18439Medicare UPIN