Provider Demographics
NPI:1801275011
Name:MARLA HAYDEN EYE CARE, LLC
Entity type:Organization
Organization Name:MARLA HAYDEN EYE CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER-HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-423-8203
Mailing Address - Street 1:304 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1891
Mailing Address - Country:US
Mailing Address - Phone:248-685-0128
Mailing Address - Fax:248-685-0359
Practice Address - Street 1:304 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1891
Practice Address - Country:US
Practice Address - Phone:248-685-0128
Practice Address - Fax:248-685-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004046152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU58427Medicare UPIN
MIN36230005Medicare PIN