Provider Demographics
NPI:1548691744
Name:CUKROWSKI EYE CENTER, PC
Entity type:Organization
Organization Name:CUKROWSKI EYE CENTER, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CUKROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-238-3603
Mailing Address - Street 1:701 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3804
Mailing Address - Country:US
Mailing Address - Phone:810-238-3603
Mailing Address - Fax:810-767-5194
Practice Address - Street 1:701 S BALLENGER HWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3804
Practice Address - Country:US
Practice Address - Phone:810-238-3603
Practice Address - Fax:810-767-5194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114861877Medicaid
MI114861877Medicaid
MI5587790001Medicare NSC