East Detroit Ophthalmology P.C.

Primary specialty

SpecialistTaxonomy code 174400000X

License

JC026758 Issued in MI

Legal business name

EAST DETROIT OPHTHALMOLOGY P.C.

Practice address

22835 Kelly Rd
Eastpointe, MI 48021-2073

Phone

(586) 778-4400

Fax

(586) 778-3642

NPI assigned

Dec 18, 2006

Organization subpart

No

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

Authorized official

Name

Dr. John Colombo, M.D.

Title

President

Phone

(586) 778-4400

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267401600000",
    "number": "1124181763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22835 KELLY RD",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480212073",
            "telephone_number": "586-778-4400",
            "fax_number": "586-778-3642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22835 KELLY RD",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480212073",
            "telephone_number": "586-778-4400",
            "fax_number": "586-778-3642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST DETROIT OPHTHALMOLOGY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2010-03-01",
        "status": "A",
        "authorized_official_last_name": "COLOMBO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-778-4400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MI",
            "license": "JC026758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3456128",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "OEO7713",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher R Dyki, DDS
• E. W. Management Inc.
• Charles Early Jr.
• Chineva Early
• Earphonics Inc
• Eastland Womens Clinic
• Eastpointe Family Dental Center
• Eastpointe Family Physicians
• Eastpointe Medical Pharmacy LLC
• Eastpointe Urgent Care Walk in Clinic P.C.

• Specialist in Eastpointe, MI
• Providers in Eastpointe, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.