Basic Information
| Provider Information | |||||||||
| NPI: | 1013085901 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID MICHIGAN OPHTHALMOLOGY PC | ||||||||
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| OtherOrganizationName: | ROSENBAUM EYE & LASER CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3390 EAST JOLLY ROAD | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173932020 | ||||||||
| FaxNumber: | 5173935050 | ||||||||
| Practice Location | |||||||||
| Address1: | 3390 E JOLLY RD | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489108547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173932020 | ||||||||
| FaxNumber: | 5173935050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 01/03/2017 | ||||||||
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| AuthorizedOfficialLastName: | GARRETT | ||||||||
| AuthorizedOfficialFirstName: | TERRY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5173932020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 4301039901 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.