Provider Demographics
NPI:1558732560
Name:YPSILANTI VISION PC
Entity Type:Organization
Organization Name:YPSILANTI VISION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ZAIR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:734-483-2100
Mailing Address - Street 1:1769 WASHTENAW RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2020
Mailing Address - Country:US
Mailing Address - Phone:734-483-2100
Mailing Address - Fax:734-483-2060
Practice Address - Street 1:1769 WASHTENAW RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2020
Practice Address - Country:US
Practice Address - Phone:734-483-2100
Practice Address - Fax:734-483-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1679887814Medicaid
MI1679887814Medicaid