Provider Demographics
NPI:1144418872
Name:BURMAN & ZUCKERBROD OPHTHALMOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:BURMAN & ZUCKERBROD OPHTHALMOLOGY ASSOCIATES, PC
Other - Org Name:GNB OPTICAL WESTLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FREEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-522-6131
Mailing Address - Street 1:7992 N WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1110
Mailing Address - Country:US
Mailing Address - Phone:734-522-6131
Mailing Address - Fax:734-522-5189
Practice Address - Street 1:7992 N WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1110
Practice Address - Country:US
Practice Address - Phone:734-522-6131
Practice Address - Fax:734-522-5189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BURMAN & ZUCKERBROD OPHTHALMOLOGY ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-09
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1798724Medicaid
MI0260780001Medicare NSC