Provider Demographics
NPI:1760733679
Name:PERSPECTIVE EYECARE
Entity Type:Organization
Organization Name:PERSPECTIVE EYECARE
Other - Org Name:PERSPECTIVE EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-699-1010
Mailing Address - Street 1:11824 BELLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2426
Mailing Address - Country:US
Mailing Address - Phone:734-699-1010
Mailing Address - Fax:734-699-6769
Practice Address - Street 1:11824 BELLEVILLE RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-2426
Practice Address - Country:US
Practice Address - Phone:734-699-1010
Practice Address - Fax:734-699-6769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003289152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5940Medicare PIN