Provider Demographics
NPI:1497789473
Name:SOMERSET OPHTHALMOLOGY PC
Entity Type:Organization
Organization Name:SOMERSET OPHTHALMOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:A
Authorized Official - Middle Name:LUISA
Authorized Official - Last Name:DILORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-822-7006
Mailing Address - Street 1:2877 CROOKS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084
Mailing Address - Country:US
Mailing Address - Phone:248-822-7003
Mailing Address - Fax:248-822-7003
Practice Address - Street 1:2877 CROOKS RD
Practice Address - Street 2:SUITE B
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4717
Practice Address - Country:US
Practice Address - Phone:248-822-7003
Practice Address - Fax:248-822-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3403090Medicaid
MI180F335510OtherBCBSMI
MI180F335510OtherBCBSMI
MI3403090Medicaid
MI5624770001Medicare NSC