Provider Demographics
NPI:1740244037
Name:NORTHWEST EYE PHYSICIANS, P.C.
Entity Type:Organization
Organization Name:NORTHWEST EYE PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOBIAS
Authorized Official - Middle Name:VALENTINE
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-682-8688
Mailing Address - Street 1:22250 PROVIDENCE DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4825
Mailing Address - Country:US
Mailing Address - Phone:248-569-4366
Mailing Address - Fax:248-569-4614
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:SUITE 304
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-569-4366
Practice Address - Fax:248-569-4614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI18OF372710OtherBLUECROSS/BLUE SHIELD NUM
MI0197220001Medicare NSC
MIOF37271Medicare PIN