Provider Demographics
NPI:1205986585
Name:MICHIGAN EYECARE INSTITUTE, P.C.
Entity type:Organization
Organization Name:MICHIGAN EYECARE INSTITUTE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESTINY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:483-522-8062
Mailing Address - Street 1:29877 TELEGRAPH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7658
Mailing Address - Country:US
Mailing Address - Phone:248-355-9111
Mailing Address - Fax:248-352-9590
Practice Address - Street 1:29877 TELEGRAPH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7658
Practice Address - Country:US
Practice Address - Phone:248-355-9111
Practice Address - Fax:248-352-9590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI368100Medicare PIN
MI0756970001Medicare NSC
MI0822602Medicare PIN