Provider Demographics
NPI:1659328664
Name:ASSOCIATED RETINAL CONSULTANTS, PC
Entity Type:Organization
Organization Name:ASSOCIATED RETINAL CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:RUBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-319-0161
Mailing Address - Street 1:2000 N HURON RIVER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2609 ELECTRIC AVE
Practice Address - Street 2:A
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6589
Practice Address - Country:US
Practice Address - Phone:810-982-1300
Practice Address - Fax:810-982-9802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
180Q26082OtherBCBS GRP #
G00698OtherBCN GRP #
791183369OtherMEDICARE RAILROAD GRP #
=========OtherGRP TAX ID #