Provider Demographics
NPI:1265699516
Name:FERMAN OPTOMETRY PC
Entity type:Organization
Organization Name:FERMAN OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMERTY
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:EALOVEGA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:734-453-4870
Mailing Address - Street 1:217 N SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1524
Mailing Address - Country:US
Mailing Address - Phone:734-453-4870
Mailing Address - Fax:734-453-2849
Practice Address - Street 1:217 N SHELDON RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170
Practice Address - Country:US
Practice Address - Phone:734-453-4870
Practice Address - Fax:734-453-2849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003867302F00000X
MI4901002583302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT93071Medicare UPIN
MIU73319Medicare UPIN