Organization
MID MICHIGAN EYE CARE CENTER, PC
Active
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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