MEDICARE: DRS. RAVIN, BIRNDORF & RAVIN, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	152W00000X	Optometrist
2	207WX0107X	Retina Specialist (Ophthalmology) Physician
3	207W00000X	Ophthalmology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CA0110	OTHER	MI	RAILROAD MEDICARE
3	DE0364	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	900D610840	OTHER	MI	BCBSM
4	180D661670	OTHER	MI	BCBSM
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316043110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS. RAVIN, BIRNDORF & RAVIN, INC.

Provider Business Mailing Address
First Line	:	850 W NORTH ST STE 104
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-3196
Country	:	US
Telephone Number	:	877-852-8463
Fax Number	:	517-817-0144

Provider Business Practice Location Address
First Line	:	3000 REGENCY CT STE 100
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-3081
Country	:	US
Telephone Number	:	419-882-2020
Fax Number	:	419-885-8440

Authorized Official
Title or Position	:	CEO
Name	:	THOMAS T ROARK
Credential	:
Telephone Number	:	517-841-3007

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/21/2022

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Directions to “DRS. RAVIN, BIRNDORF & RAVIN, INC. ” Practice Location

Language	Start Address	Practice Location

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