Provider Demographics
NPI:1679781306
Name:TUKEL -KOZLOW EYE CENTER, PC
Entity Type:Organization
Organization Name:TUKEL -KOZLOW EYE CENTER, PC
Other - Org Name:TUKEL EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:TUKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-274-7540
Mailing Address - Street 1:1922 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2917
Mailing Address - Country:US
Mailing Address - Phone:313-274-7540
Mailing Address - Fax:313-274-7544
Practice Address - Street 1:1922 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2917
Practice Address - Country:US
Practice Address - Phone:313-274-7540
Practice Address - Fax:313-274-7544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOH24984OtherBLUE CROSS GROUP NUMBER
MIOH24984OtherBLUE CROSS GROUP NUMBER