MEDICARE: DR. GARY S OPPENHEIM OD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901002613	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	900F366860	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1689656837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY S OPPENHEIM OD

Provider Business Mailing Address
First Line	:	33308 GRAND RIVER AVE
Second Line	:
City	:	FARMINGTON
State	:	MI
Zip	:	48336-3124
Country	:	US
Telephone Number	:	248-474-5125
Fax Number	:	248-474-4854

Provider Business Practice Location Address
First Line	:	33308 GRAND RIVER AVE
Second Line	:
City	:	FARMINGTON
State	:	MI
Zip	:	48336-3124
Country	:	US
Telephone Number	:	248-474-5125
Fax Number	:	248-474-4854

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	05/14/2010

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