Provider Demographics
NPI:1255510525
Name:EYE SURGERY CENTER OF MICHIGAN LLC
Entity type:Organization
Organization Name:EYE SURGERY CENTER OF MICHIGAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GROSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-333-2900
Mailing Address - Street 1:3455 LIVERNOIS RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5063
Mailing Address - Country:US
Mailing Address - Phone:248-619-2020
Mailing Address - Fax:248-619-7150
Practice Address - Street 1:3455 LIVERNOIS
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5063
Practice Address - Country:US
Practice Address - Phone:248-619-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P57910Medicare UPIN