Provider Demographics
NPI:1215012356
Name:KENZIE EYE CARE INC.
Entity type:Organization
Organization Name:KENZIE EYE CARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANSCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-455-3190
Mailing Address - Street 1:44750 FORD RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2942
Mailing Address - Country:US
Mailing Address - Phone:734-455-3190
Mailing Address - Fax:734-455-1510
Practice Address - Street 1:44750 FORD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2942
Practice Address - Country:US
Practice Address - Phone:734-455-3190
Practice Address - Fax:734-455-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP21620Medicare PIN
MI0246420001Medicare NSC