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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