| Organization Name: | CEDAR RUN EYE CENTER, PLLC |
| NPI Number: | 1518029909 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TIMOTHY B. HANLEY (OWNER) |
| Mailing Address: | 3830 W Front St Traverse City |
| State: | MI US |
| Postal Code: | 496848153 |
| Phone Number: | 2319293888 |
| Fax Number: | 2319294365 |
| NPI Enumeration Date: | 12/14/2006 |
| NPI Last Update Date: | 05/11/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 4301048021 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |