Provider Demographics
NPI:1326238395
Name:MILLMAN-DERR CENTER FOR EYE CARE, P.C.
Entity Type:Organization
Organization Name:MILLMAN-DERR CENTER FOR EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-852-3636
Mailing Address - Street 1:PO BOX 80070
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48308-0070
Mailing Address - Country:US
Mailing Address - Phone:248-852-3636
Mailing Address - Fax:248-852-3631
Practice Address - Street 1:375 BARCLAY CIR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4511
Practice Address - Country:US
Practice Address - Phone:248-852-3636
Practice Address - Fax:248-852-3631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F36432Medicare PIN