Provider Demographics
NPI:1528061918
Name:CATARACT SPECIALTY SURGICAL CENTER, LLC
Entity type:Organization
Organization Name:CATARACT SPECIALTY SURGICAL CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JANKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:248-586-4602
Mailing Address - Street 1:28747 WOODWARD AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-0914
Mailing Address - Country:US
Mailing Address - Phone:248-584-4602
Mailing Address - Fax:248-584-4630
Practice Address - Street 1:28747 WOODWARD AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0931
Practice Address - Country:US
Practice Address - Phone:248-584-4602
Practice Address - Fax:248-584-4630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
MI636901261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00089786OtherRR MEDICARE
P00089786OtherRR MEDICARE