Provider Demographics
NPI:1972680577
Name:UNIVERSITY EYE CARE, PC
Entity Type:Organization
Organization Name:UNIVERSITY EYE CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ROLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-884-5160
Mailing Address - Street 1:44344 DEQUINDRE RD
Mailing Address - Street 2:STE. 110
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1038
Mailing Address - Country:US
Mailing Address - Phone:586-884-5160
Mailing Address - Fax:586-884-5165
Practice Address - Street 1:44344 DEQUINDRE RD
Practice Address - Street 2:STE. 110
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1038
Practice Address - Country:US
Practice Address - Phone:586-884-5160
Practice Address - Fax:586-884-5165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003679152W00000X
MI4901004259152W00000X
MI4301058346207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
180046164OtherRAILROAD MEDICARE
MI0P37820Medicare PIN
P37820001Medicare PIN
MIE62062Medicare UPIN
MI0N62910Medicare ID - Type Unspecified
180046164OtherRAILROAD MEDICARE