Organization
EYE TRAVEL,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA ZACKS (TREASURER)
(248) 569-7747
Entity
Organization
Contact information
Practice address
15914 JEANETTE ST, SOUTHFIELD, MI 48075-2013
(248) 569-7747
(248) 569-7054
Mailing address
15914 JEANETTE ST, SOUTHFIELD, MI 48075-2013
(248) 569-7747
(248) 569-7054
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F36342
BLUE CROSS
MI
Enumeration date
09/14/2006
Last updated
04/23/2012
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