Organization
REGENTS OF THE UNIVERSITY OF MICHIGAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID CHRISTOPHER MILLER MD (PRESIDENT)
(734) 936-3568
Entity
Organization
Contact information
Practice address
5728 WHITMORE LAKE RD, BRIGHTON, MI 48116
(810) 227-2357
Mailing address
3621 S STATE ST, PROVIDER ENROLLMENT, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
152WC0802X
Corneal and Contact Management Optometrist
—
—
152WL0500X
Low Vision Rehabilitation Optometrist
—
—
152WP0200X
Pediatric Optometrist
—
—
152WS0006X
Sports Vision Optometrist
—
—
152WV0400X
Vision Therapy Optometrist
—
—
152WX0102X
Occupational Vision Optometrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900D711550
BCBS
MI
Enumeration date
07/13/2006
Last updated
04/30/2021
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