Organization
NORTHWEST EYE FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK S JUZYCH MD (MANAGER)
(248) 581-5973
Entity
Organization
Contact information
Practice address
6071 W OUTER DR, M-106, DETROIT, MI 48235-2624
(313) 966-2024
(313) 966-7418
Mailing address
1560 E. MAPLE RD., SUITE 400-CREDENTIALING, TROY, MI 48083-1189
(248) 581-5973
(248) 581-5640
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H24365
BCBSM GROUP#
MI
Enumeration date
03/19/2009
Last updated
09/29/2014
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