Provider Demographics
NPI:1508054230
Name:BURMAN & ZUCKERBROD OPHTHALMOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:BURMAN & ZUCKERBROD OPHTHALMOLOGY ASSOCIATES, PC
Other - Org Name:GNB OPTICAL DETROIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-341-3450
Mailing Address - Street 1:14400 W MCNICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-3916
Mailing Address - Country:US
Mailing Address - Phone:313-341-3450
Mailing Address - Fax:313-341-2135
Practice Address - Street 1:14400 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3916
Practice Address - Country:US
Practice Address - Phone:313-341-3450
Practice Address - Fax:313-341-2135
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BURMAN & ZUCKERBROD OPHTHALMOLOGY ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-09
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1798751Medicaid
MI0260780001Medicare NSC