Provider Demographics
NPI:1215919113
Name:VISION INSTITUTE OF MICHIGAN SURGERY CENTER PC
Entity type:Organization
Organization Name:VISION INSTITUTE OF MICHIGAN SURGERY CENTER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-254-1770
Mailing Address - Street 1:44650 DELCO BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1063
Mailing Address - Country:US
Mailing Address - Phone:586-254-3391
Mailing Address - Fax:586-254-3344
Practice Address - Street 1:44650 DELCO BLVD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1024
Practice Address - Country:US
Practice Address - Phone:586-254-3391
Practice Address - Fax:586-254-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI506819261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI40360OtherBCBSM
MI40360OtherBCBSM