Organization
MICHIGAN VISION INSTITUTE PLLC
Active
Organization
MICHIGAN VISION INSTITUTE PLLC
Active
Other names
Michigan Vision Institute
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD PATRICK STACK M.D. (PHYSICIAN)
(810) 720-9111
Entity
Organization
Contact information
Practice address
5300 GATEWAY CTR, FLINT, MI 48507-3930
(810) 720-9111
(810) 720-9119
Mailing address
5300 GATEWAY CTR, FLINT, MI 48507-3930
(810) 720-9111
(810) 720-9119
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301065179
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000013286
—
MI
01
—
0995895
HEALTHPLUS OF MICHIGAN
MI
01
—
1015959
MCLAREN HEALTH ADV
MI
01
—
1802511821
BCBSM
MI
05
—
4774225
—
MI
01
—
5100110
AETNA
MI
01
—
C6993
MCARE
MI
01
—
G08694
HAP
MI
Enumeration date
12/14/2006
Last updated
07/25/2022
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