Basic Information
Provider Information
NPI: 1518112978
EntityType: 2
ReplacementNPI:  
OrganizationName: SWITCH EYE CENTER, PC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8950 TELEGRAPH RD
Address2:  
City: TAYLOR
State: MI
PostalCode: 481808399
CountryCode: US
TelephoneNumber: 3132953937
FaxNumber: 3132952006
Practice Location
Address1: 8950 TELEGRAPH RD
Address2:  
City: TAYLOR
State: MI
PostalCode: 481808399
CountryCode: US
TelephoneNumber: 3132953937
FaxNumber: 3132952006
Other Information
ProviderEnumerationDate: 11/25/2008
LastUpdateDate: 04/06/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SWITCH
AuthorizedOfficialFirstName: SHEALYNN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: ADMIN
AuthorizedOfficialTelephone: 3132953937
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000X5101009244MIY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOphthalmology 

No ID Information.


Home