Provider Demographics
NPI:1255342366
Name:MILLMAN-DERR CENTER FOR EYE CARE, P.C.
Entity type:Organization
Organization Name:MILLMAN-DERR CENTER FOR EYE CARE, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEPORTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-396-8109
Mailing Address - Street 1:PO BOX 80070
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48308-0070
Mailing Address - Country:US
Mailing Address - Phone:248-491-8894
Mailing Address - Fax:248-247-6610
Practice Address - Street 1:375 BARCLAY CIR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4511
Practice Address - Country:US
Practice Address - Phone:248-852-3636
Practice Address - Fax:248-852-3631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI636825261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F37004Medicare PIN