Provider Demographics
NPI:1740056589
Name:NEO OCULOPLASTIC P.C.
Entity type:Organization
Organization Name:NEO OCULOPLASTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRCHEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-673-2946
Mailing Address - Street 1:44067 GREENVIEW LN
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8454
Mailing Address - Country:US
Mailing Address - Phone:734-673-2946
Mailing Address - Fax:
Practice Address - Street 1:44067 GREENVIEW LN
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-8454
Practice Address - Country:US
Practice Address - Phone:734-673-2946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Single Specialty