Provider Demographics
NPI:1780820845
Name:PROGRESSIVE FAMILY EYE CARE PLLC
Entity Type:Organization
Organization Name:PROGRESSIVE FAMILY EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DIPONIO-TULCHINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:734-660-1141
Mailing Address - Street 1:487 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1721
Mailing Address - Country:US
Mailing Address - Phone:734-414-1892
Mailing Address - Fax:734-414-1962
Practice Address - Street 1:487 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1721
Practice Address - Country:US
Practice Address - Phone:734-414-1892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-19
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004390152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1347Medicare PIN