Provider Demographics
NPI:1912155961
Name:COOK & HAYDEN VISION CARE CENTER
Entity Type:Organization
Organization Name:COOK & HAYDEN VISION CARE CENTER
Other - Org Name:COOK & HAYDEN LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:
Authorized Official - Last Name:URBANCIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-227-2004
Mailing Address - Street 1:420 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1516
Mailing Address - Country:US
Mailing Address - Phone:810-227-2004
Mailing Address - Fax:810-227-9910
Practice Address - Street 1:420 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1516
Practice Address - Country:US
Practice Address - Phone:810-227-2004
Practice Address - Fax:810-227-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002643152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI945212103Medicaid
MI6074730001Medicare NSC
MIMI1453Medicare PIN