Provider Demographics
NPI:1386074839
Name:PATIENT CENTERED EYE CARE LLC
Entity type:Organization
Organization Name:PATIENT CENTERED EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ELAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-759-1123
Mailing Address - Street 1:2014 HOLLAND AVE
Mailing Address - Street 2:STE 366
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-1406
Mailing Address - Country:US
Mailing Address - Phone:502-759-1123
Mailing Address - Fax:
Practice Address - Street 1:2014 HOLLAND AVE
Practice Address - Street 2:STE 366
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-1406
Practice Address - Country:US
Practice Address - Phone:502-759-1123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004752152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty