Provider Demographics
NPI:1598798746
Name:MACOMB FAMILY EYE CARE PC
Entity Type:Organization
Organization Name:MACOMB FAMILY EYE CARE PC
Other - Org Name:INSIGHT EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:586-421-2020
Mailing Address - Street 1:21780 21 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-2974
Mailing Address - Country:US
Mailing Address - Phone:586-421-2020
Mailing Address - Fax:586-421-2022
Practice Address - Street 1:21780 21 MILE RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-2974
Practice Address - Country:US
Practice Address - Phone:586-421-2020
Practice Address - Fax:586-421-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6169500001Medicare NSC