Provider Demographics
NPI:1114249141
Name:MICHIGAN OPTOMETRY PC
Entity Type:Organization
Organization Name:MICHIGAN OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJAJ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-747-4496
Mailing Address - Street 1:50854 CALVERT ISLE DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-2559
Mailing Address - Country:US
Mailing Address - Phone:914-522-8273
Mailing Address - Fax:
Practice Address - Street 1:33201 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-5924
Practice Address - Country:US
Practice Address - Phone:586-939-8204
Practice Address - Fax:586-939-8202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty