Provider Demographics
NPI:1194471029
Name:MICHIGAN OPHTHALMOLOGY SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:MICHIGAN OPHTHALMOLOGY SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZWICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-395-5166
Mailing Address - Street 1:30150 TELEGRAPH RD STE 271
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4521
Mailing Address - Country:US
Mailing Address - Phone:248-395-5166
Mailing Address - Fax:
Practice Address - Street 1:47670 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-3302
Practice Address - Country:US
Practice Address - Phone:586-250-2972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty