Organization
PORT HURON OPHTHALMOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA JEAN FAVERO (ADMINISTRATOR)
(810) 985-9600
Entity
Organization
Contact information
Practice address
1660 STONE ST, PORT HURON, MI 48060-3344
(810) 985-9600
(810) 985-9244
Mailing address
1660 STONE ST, PORT HURON, MI 48060-3344
(810) 985-9600
(810) 985-9244
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
BF064615
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180028563
UNITED HEALTHCARE
MI
01
—
180G412660
BCBSM GRP
MI
Enumeration date
07/30/2006
Last updated
11/24/2021
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