Provider Demographics
NPI:1306906540
Name:EYE CENTER OF LENAWEE P.C.
Entity type:Organization
Organization Name:EYE CENTER OF LENAWEE P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-265-5444
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-0336
Mailing Address - Country:US
Mailing Address - Phone:517-265-5444
Mailing Address - Fax:517-264-5182
Practice Address - Street 1:1400 W MAUMEE ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1804
Practice Address - Country:US
Practice Address - Phone:517-265-5444
Practice Address - Fax:517-264-5182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0397300001Medicare NSC