Organization
REGENTS OF THE UNIVERSITY OF MICHIGAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID CHRISTOPHER MILLER (PRESIDENT)
(734) 936-3568
Entity
Organization
Contact information
Practice address
1000 WALL ST, ANN ARBOR, MI 48105
(734) 763-1415
Mailing address
3621 S STATE ST, PROVIDER ENROLLMENT, ANN ARBOR, MI 48108
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
152WC0802X
Corneal and Contact Management Optometrist
—
—
152WL0500X
Low Vision Rehabilitation Optometrist
—
—
152WP0200X
Pediatric Optometrist
—
—
152WS0006X
Sports Vision Optometrist
—
—
152WV0400X
Vision Therapy Optometrist
—
—
152WX0102X
Occupational Vision Optometrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900Q17650
BCBS
MI
Enumeration date
07/13/2006
Last updated
05/03/2021
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