Provider Demographics
NPI:1154436335
Name:LIVINGSTON EYECARE ASSOCIATES, LLC
Entity type:Organization
Organization Name:LIVINGSTON EYECARE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, LLC / OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:GALLATIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-231-5800
Mailing Address - Street 1:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48139-0767
Mailing Address - Country:US
Mailing Address - Phone:810-231-5800
Mailing Address - Fax:810-231-6422
Practice Address - Street 1:7486 EAST M-36
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:MI
Practice Address - Zip Code:48139
Practice Address - Country:US
Practice Address - Phone:810-231-5800
Practice Address - Fax:810-231-6422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003817152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4901003817OtherOPTOMETRY LICENSE
MIOM92850Medicare ID - Type Unspecified
MI4385070001Medicare NSC
MI4901003817OtherOPTOMETRY LICENSE