Provider Demographics
NPI:1235481516
Name:CHILDREN'S EYE CARE, PC
Entity Type:Organization
Organization Name:CHILDREN'S EYE CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOKOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-254-8140
Mailing Address - Street 1:6689 ORCHARD LAKE RD # 297
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3404
Mailing Address - Country:US
Mailing Address - Phone:248-254-8140
Mailing Address - Fax:248-254-8150
Practice Address - Street 1:7001 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3604
Practice Address - Country:US
Practice Address - Phone:248-538-7400
Practice Address - Fax:248-538-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003317152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P47480Medicare PIN