Provider Demographics
NPI:1669553368
Name:EYE CARE ASSOCIATES PC
Entity type:Organization
Organization Name:EYE CARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-380-8066
Mailing Address - Street 1:26850 PROVIDENCE PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1254
Mailing Address - Country:US
Mailing Address - Phone:248-380-8066
Mailing Address - Fax:248-569-5729
Practice Address - Street 1:26850 PROVIDENCE PKWY STE 150
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1254
Practice Address - Country:US
Practice Address - Phone:248-380-8066
Practice Address - Fax:248-380-8087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049740207W00000X
MI4301070263207W00000X
MI4301021236207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4370663Medicaid
MI1735608Medicaid
MI1099581Medicaid
MI2863756Medicaid
MI4370654Medicaid
MIB46512Medicare UPIN
MIH34926Medicare UPIN
MI4370663Medicaid
MI1099581Medicaid
MI2863756Medicaid
MI0M11510005Medicare ID - Type Unspecified