Provider Demographics
NPI:1760687495
Name:OAKLAND EYE CLINIC,PC
Entity Type:Organization
Organization Name:OAKLAND EYE CLINIC,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKIMZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-856-6500
Mailing Address - Street 1:75 BARCLAY CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5803
Mailing Address - Country:US
Mailing Address - Phone:248-856-6500
Mailing Address - Fax:248-856-6504
Practice Address - Street 1:75 BARCLAY CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5803
Practice Address - Country:US
Practice Address - Phone:248-856-6500
Practice Address - Fax:248-856-6504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRH064286174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM28920Medicare PIN
MIF59096Medicare UPIN