Provider Demographics
NPI:1730135807
Name:ASSOCIATED RETINAL CONSULTANTS, PC
Entity type:Organization
Organization Name:ASSOCIATED RETINAL CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:TRESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-288-2269
Mailing Address - Street 1:2000 N HURON RIVER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20952 12 MILE RD
Practice Address - Street 2:140
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081
Practice Address - Country:US
Practice Address - Phone:586-552-2092
Practice Address - Fax:586-552-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00698OtherBCN GRP #
180Q26082OtherBCBS GRP #
791183369OtherMEDICARE RAILROAD GRP #
180Q26082OtherBCBS GRP #