Provider Demographics
NPI:1588857684
Name:KENZIE EYE CARE INC.
Entity Type:Organization
Organization Name:KENZIE EYE CARE INC.
Other - Org Name:DBA ELITE EYECARE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:BOBBISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-261-6868
Mailing Address - Street 1:29316 FORD RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2848
Mailing Address - Country:US
Mailing Address - Phone:734-261-6868
Mailing Address - Fax:
Practice Address - Street 1:29316 FORD RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2848
Practice Address - Country:US
Practice Address - Phone:734-261-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2022-07-21
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
MIDU0080Medicare PIN
MI0P21620Medicare PIN
MI0246420002Medicare NSC