Basic Information
| Provider Information | |||||||||
| NPI: | 1003154014 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SWITCH EYE CENTER, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8950 TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | TAYLOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481808399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132953937 | ||||||||
| FaxNumber: | 3132952006 | ||||||||
| Practice Location | |||||||||
| Address1: | 1218 S TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481615516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132953937 | ||||||||
| FaxNumber: | 3132952006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2013 | ||||||||
| LastUpdateDate: | 01/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | SWITCH | ||||||||
| AuthorizedOfficialFirstName: | JEROME | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3132953937 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SWITCH EYE CENTER, P.C. | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 5101009244 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.