Provider Demographics
NPI:1316043110
Name:DRS. RAVIN, BIRNDORF & RAVIN, INC.
Entity Type:Organization
Organization Name:DRS. RAVIN, BIRNDORF & RAVIN, INC.
Other - Org Name:SPECIALTY EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-841-3007
Mailing Address - Street 1:850 W NORTH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3196
Mailing Address - Country:US
Mailing Address - Phone:877-852-8463
Mailing Address - Fax:517-817-0144
Practice Address - Street 1:3000 REGENCY CT STE 100
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3081
Practice Address - Country:US
Practice Address - Phone:419-882-2020
Practice Address - Fax:419-885-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900D610840OtherBCBSM
MICA0110OtherRAILROAD MEDICARE
MIDE0364OtherRAILROAD MEDICARE
MI180D661670OtherBCBSM
OH0630320Medicaid
OH9921364Medicare PIN
OH9921366Medicare PIN
MI0P19530Medicare PIN
MI900D610840OtherBCBSM
OH9921365Medicare PIN
MI0D66167Medicare PIN
OH9921369Medicare PIN