Provider Demographics
NPI:1386671824
Name:BALIAN EYE CENTER, LLC
Entity Type:Organization
Organization Name:BALIAN EYE CENTER, LLC
Other - Org Name:BALIAN EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TEKIELE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-853-0409
Mailing Address - Street 1:432 W. UNIVERSITY DR.
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-651-6122
Mailing Address - Fax:248-651-4825
Practice Address - Street 1:432 W. UNIVERSITY DR.
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-651-6122
Practice Address - Fax:248-651-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
490000121OtherMC RAILROAD ASC
0F37002Medicare ID - Type UnspecifiedASC