Provider Demographics
NPI:1023198603
Name:ASSOCIATES IN OPHTHALMOLOGY PC
Entity type:Organization
Organization Name:ASSOCIATES IN OPHTHALMOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HART
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:248-855-1020
Mailing Address - Street 1:27555 FARMINGTON RD
Mailing Address - Street 2:STE 130
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3376
Mailing Address - Country:US
Mailing Address - Phone:248-855-1020
Mailing Address - Fax:248-855-2639
Practice Address - Street 1:27555 FARMINGTON RD
Practice Address - Street 2:STE 130
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3376
Practice Address - Country:US
Practice Address - Phone:248-855-1020
Practice Address - Fax:248-855-2639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N40420Medicare ID - Type Unspecified