Provider Demographics
NPI:1114565249
Name:LEGACY EYE INSTITUTE PLC
Entity Type:Organization
Organization Name:LEGACY EYE INSTITUTE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ATHEAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALRAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-229-8436
Mailing Address - Street 1:811 EAST ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3033
Mailing Address - Country:US
Mailing Address - Phone:810-267-9700
Mailing Address - Fax:810-356-5819
Practice Address - Street 1:811 EAST ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3033
Practice Address - Country:US
Practice Address - Phone:810-267-9700
Practice Address - Fax:810-356-5819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11810958OtherCAQH