Provider Demographics
NPI:1316111628
Name:ADVANCED OPHTHALMOLOGY ASSOCIATES PLC
Entity type:Organization
Organization Name:ADVANCED OPHTHALMOLOGY ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-589-9500
Mailing Address - Street 1:330 E 14 MILE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-2100
Mailing Address - Country:US
Mailing Address - Phone:248-589-9500
Mailing Address - Fax:
Practice Address - Street 1:330 E 14 MILE RD
Practice Address - Street 2:SUITE B
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-2100
Practice Address - Country:US
Practice Address - Phone:248-589-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4902940001Medicare NSC
MI0N55680Medicare PIN