| Wayne State University Physician Group | |
|
4717 Saint Antoine St, Detroit, MI 48201-1423 | |
| (313) 577-8900 | |
| (313) 577-0700 |
| Full Name | Wayne State University Physician Group |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 4717 Saint Antoine St, Detroit, Michigan |
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063452233 | NPI | - | NPPES |
| 0P32140 | Other | MI | MEDICARE GROUP # - OD |
| 23D1091632 | Other | MI | CLIA WAIVER |
| 0H22869 | Other | MI | BCBSM GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | (* (Not Available)) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Wayne State University Physician Group 1560 E. Maple Rd., Suite 400-credentialing Dept., Troy, MI 48083-1138 Ph: (248) 581-5973 | Wayne State University Physician Group 4717 Saint Antoine St, Detroit, MI 48201-1423 Ph: (313) 577-8900 |
Kayleigh Rohr, OD Optometrist Medicare: Not Enrolled in Medicare Practice Location: 4646 John R St, Detroit, MI 48201 Phone: 313-576-1000 | |
Dr. Robert Fredrick Lee Iii, O.D. Optometrist Medicare: Medicare Enrolled Practice Location: 15157 Gratiot Ave, Detroit, MI 48205 Phone: 313-526-7664 Fax: 313-526-2055 | |
Dr. Sura Hassan, OD Optometrist Medicare: Medicare Enrolled Practice Location: 4717 St. Antoine, Kresge Eye Institute, Detroit, MI 48201 Phone: 313-577-8900 Fax: 313-577-0700 | |
Dr. Richard Edwin Gay, OD Optometrist Medicare: Medicare Enrolled Practice Location: 19173 Mack Ave, Detroit, MI 48230 Phone: 313-882-7883 Fax: 313-882-5128 | |
Heritage Optical Inc. Optometrist Medicare: Not Enrolled in Medicare Practice Location: 2678 E Jefferson Ave, Detroit, MI 48207 Phone: 313-259-6006 | |
Dr. Linda Le, Optometrist Medicare: Not Enrolled in Medicare Practice Location: 1301 Orleans St Apt 1705, Detroit, MI 48207 Phone: 248-759-9202 |