Provider Demographics
NPI:1982709861
Name:EYE TRAVEL,PC
Entity Type:Organization
Organization Name:EYE TRAVEL,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-569-7747
Mailing Address - Street 1:15914 JEANETTE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2013
Mailing Address - Country:US
Mailing Address - Phone:248-569-7747
Mailing Address - Fax:248-569-7054
Practice Address - Street 1:15914 JEANETTE ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2013
Practice Address - Country:US
Practice Address - Phone:248-569-7747
Practice Address - Fax:248-569-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F36342OtherBLUE CROSS