NPIMap

Organization Active NPI

Eastside Eye Physicians, PC

  • Ophthalmology Physician
  • Saint Clair Shores, MI
National Provider Identifier
1093814188
Registry record updated Jan 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
EASTSIDE EYE PHYSICIANS, PC
Practice address
25511 Little Mack Ave
Saint Clair Shores, MI 48081-3372
Phone
(586) 774-2020
NPI assigned
Sep 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Anne M Nachazel, MDNPI 1629064183
Title
President
Phone
(586) 774-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

25511 Little Mack Ave
Saint Clair Shores, MI 48081-3372

Mailing address

25511 Little Mack Ave
Saint Clair Shores, MI 48081-3372

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040802000097 MI Part B Supplier - Clinic/Group Practice 3678560018 Receives reassigned benefits from 9 practitioners
Practice locations: Saint Clair Shores, MI; Shelby Township, MI

National Provider Directory

National Provider Directory

Locations

47100 Schoenherr Rd
Shelby Township, MI 48315
Phone (586) 532-9800

25511 Little Mack Ave
St Clr Shores, MI 48081
Phone (586) 774-2020

3455 Livernois Rd
Troy, MI 48083
Phone (248) 619-2020

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201219200000",
    "number": "1093814188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25511 LITTLE MACK AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480813372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25511 LITTLE MACK AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480813372",
            "telephone_number": "586-774-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE EYE PHYSICIANS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2008-01-25",
        "status": "A",
        "authorized_official_last_name": "NACHAZEL",
        "authorized_official_first_name": "ANNE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-774-2020",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.