Provider Demographics
NPI:1053342568
Name:BRIGHTON VISION CENTER, PLC
Entity type:Organization
Organization Name:BRIGHTON VISION CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FARJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-494-2020
Mailing Address - Street 1:2305 GENOA BUSINESS PARK DR.
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114
Mailing Address - Country:US
Mailing Address - Phone:810-494-2020
Mailing Address - Fax:810-494-0127
Practice Address - Street 1:2305 GENOA BUSINESS PARK DR.
Practice Address - Street 2:SUITE 250
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114
Practice Address - Country:US
Practice Address - Phone:810-494-2020
Practice Address - Fax:810-494-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2012-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI18-0-D7-1162-0OtherBCBSM PIN #
MI0P30920Medicare ID - Type UnspecifiedGROUP NUMBER