Provider Demographics
NPI:1306963921
Name:EYE CARE ASSOCIATES OF MICHIGAN P C
Entity type:Organization
Organization Name:EYE CARE ASSOCIATES OF MICHIGAN P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:ZUCKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-476-4130
Mailing Address - Street 1:20210 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1412
Mailing Address - Country:US
Mailing Address - Phone:248-476-4130
Mailing Address - Fax:248-476-2540
Practice Address - Street 1:20210 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1412
Practice Address - Country:US
Practice Address - Phone:248-476-4130
Practice Address - Fax:248-476-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI111828556Medicaid
MI0574840001Medicare NSC
MICM8857Medicare PIN
MI111828556Medicaid