Provider Demographics
NPI:1689685976
Name:ASSOCIATED EYE INSTITUTES OF DETROIT, PC
Entity Type:Organization
Organization Name:ASSOCIATED EYE INSTITUTES OF DETROIT, PC
Other - Org Name:YALDO EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-278-4540
Mailing Address - Street 1:65 CADILLAC SQ
Mailing Address - Street 2:STE 105
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-2844
Mailing Address - Country:US
Mailing Address - Phone:313-963-8411
Mailing Address - Fax:
Practice Address - Street 1:65 CADILLAC SQ
Practice Address - Street 2:STE 105
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-2844
Practice Address - Country:US
Practice Address - Phone:313-963-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M18190Medicare ID - Type Unspecified