Provider Demographics
NPI:1427219625
Name:MEDICAL ARTS EYE CARE PC
Entity Type:Organization
Organization Name:MEDICAL ARTS EYE CARE PC
Other - Org Name:DONAHUE EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-242-8630
Mailing Address - Street 1:750 STEWART RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-4291
Mailing Address - Country:US
Mailing Address - Phone:734-242-8630
Mailing Address - Fax:734-242-8666
Practice Address - Street 1:750 STEWART RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4279
Practice Address - Country:US
Practice Address - Phone:734-242-8630
Practice Address - Fax:734-242-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICB002739152W00000X
MIKC003966152W00000X
MI4901002739332B00000X, 335E00000X
MI490102739332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332H00000XSuppliersEyewear Supplier
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900E80015OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MIDR6060OtherRETIRED RAILROAD MEDICARE
MI1427219625Medicaid
MI1427219625Medicaid
MIMI1548Medicare PIN