Provider Demographics
NPI:1194788539
Name:HURON OPHTHALMOLOGY PC
Entity type:Organization
Organization Name:HURON OPHTHALMOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-434-6000
Mailing Address - Street 1:5477 W CLARK RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1102
Mailing Address - Country:US
Mailing Address - Phone:734-528-0718
Mailing Address - Fax:734-528-0719
Practice Address - Street 1:5477 W CLARK RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1102
Practice Address - Country:US
Practice Address - Phone:734-528-0718
Practice Address - Fax:734-528-0719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0703960001Medicare ID - Type Unspecified