Organization
EAST DETROIT OPHTHALMOLOGY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN COLOMBO M.D. (PRESIDENT)
(586) 778-4400
Entity
Organization
Contact information
Practice address
22835 KELLY RD, EASTPOINTE, MI 48021-2073
(586) 778-4400
(586) 778-3642
Mailing address
22835 KELLY RD, EASTPOINTE, MI 48021-2073
(586) 778-4400
(586) 778-3642
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
JC026758
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3456128
—
MI
01
—
OEO7713
BLUE CROSS BLUE SHIELD
MI
Enumeration date
12/18/2006
Last updated
03/01/2010
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