Provider Demographics
NPI:1114176500
Name:TAKAHASHI EYE CARE PC
Entity Type:Organization
Organization Name:TAKAHASHI EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:K
Authorized Official - Last Name:TAKAHASHI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:734-332-8840
Mailing Address - Street 1:955 W EISENHOWER CIR
Mailing Address - Street 2:SUITE F
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5868
Mailing Address - Country:US
Mailing Address - Phone:734-332-8840
Mailing Address - Fax:
Practice Address - Street 1:955 W EISENHOWER CIR
Practice Address - Street 2:SUITE F
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5868
Practice Address - Country:US
Practice Address - Phone:734-332-8840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003036261QH0100X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI3948Medicare PIN