Provider Demographics
NPI:1306269436
Name:NORTHWEST EYE PHYSICIANS, P.C.
Entity type:Organization
Organization Name:NORTHWEST EYE PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-569-4366
Mailing Address - Street 1:22250 PROVIDENCE DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4825
Mailing Address - Country:US
Mailing Address - Phone:248-569-4366
Mailing Address - Fax:248-569-4614
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:SUITE 440
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1213
Practice Address - Country:US
Practice Address - Phone:248-380-8280
Practice Address - Fax:248-380-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier