Provider Demographics
NPI:1487782470
Name:EASTSIDE EYE PHYSICIANS, PC
Entity type:Organization
Organization Name:EASTSIDE EYE PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NACHAZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-247-2020
Mailing Address - Street 1:47100 SCHOENHERR RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4716
Mailing Address - Country:US
Mailing Address - Phone:586-247-2020
Mailing Address - Fax:586-247-5500
Practice Address - Street 1:47100 SCHOENHERR RD
Practice Address - Street 2:SUITE F
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4716
Practice Address - Country:US
Practice Address - Phone:586-247-2020
Practice Address - Fax:586-247-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0696930001Medicare NSC