Provider Demographics
NPI:1346390572
Name:BEITMAN LASER EYE INSTITUTE PC
Entity Type:Organization
Organization Name:BEITMAN LASER EYE INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BEITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-855-6200
Mailing Address - Street 1:5813 W MAPLE RD
Mailing Address - Street 2:#137
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4400
Mailing Address - Country:US
Mailing Address - Phone:348-855-6200
Mailing Address - Fax:248-855-7721
Practice Address - Street 1:5813 W MAPLE RD
Practice Address - Street 2:#137
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4400
Practice Address - Country:US
Practice Address - Phone:348-855-6200
Practice Address - Fax:248-855-7721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRB038148261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center