Provider Demographics
NPI:1538235627
Name:BRIAN M. CARNEY P.C.
Entity type:Organization
Organization Name:BRIAN M. CARNEY P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:734-453-6190
Mailing Address - Street 1:1358 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2253
Mailing Address - Country:US
Mailing Address - Phone:734-453-6190
Mailing Address - Fax:734-453-4640
Practice Address - Street 1:1358 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2253
Practice Address - Country:US
Practice Address - Phone:734-453-6190
Practice Address - Fax:734-453-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0605750001Medicare NSC