Organization
MID MICHIGAN EYE CARE CENTER, PC
Active
Other names
Specialty Eye Institute
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS T ROARK (CEO)
(517) 841-3007
Entity
Organization
Contact information
Practice address
1116 W. GANSON STREET, JACKSON, MI 49202-4240
(877) 852-8463
(517) 817-0144
Mailing address
850 W. NORTH STREET, STE. 104, JACKSON, MI 49202-3196
(877) 852-8463
(517) 817-0144
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
4301034151
MI
207W00000X
Ophthalmology Physician
Primary
—
—
207WX0107X
Retina Specialist (Ophthalmology) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180C846310
BCBSM
MI
01
—
180H149970
BCBSM
MI
01
—
900C848370
BCBSM
MI
01
—
900H115380
BCBSM
—
01
—
900N834800
BCBSM
MI
01
—
C31544
RAILROAD MEDICARE
MI
01
—
CC5220
RAILROAD MEDICARE
MI
Enumeration date
06/14/2005
Last updated
11/26/2018
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