Provider Demographics
NPI:1215078126
Name:EYE CLINIC OF LIVONIA, P.C.
Entity type:Organization
Organization Name:EYE CLINIC OF LIVONIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:COYE
Authorized Official - Middle Name:T
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-462-1197
Mailing Address - Street 1:37650 PROFESSIONAL CENTER DR STE 125A
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1139
Mailing Address - Country:US
Mailing Address - Phone:734-462-1197
Mailing Address - Fax:734-462-1496
Practice Address - Street 1:37650 PROFESSIONAL CENTER DR STE 125A
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1139
Practice Address - Country:US
Practice Address - Phone:734-462-1197
Practice Address - Fax:734-462-1496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI043658174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0823099Medicare ID - Type UnspecifiedOPHTHALMOLOGY