MEDICARE: OAKLAND OPHTHALMIC SURGERY PC

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	207W00000X	Ophthalmology Physician		MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0F37296	OTHER		BCBSM
2	180F372960	OTHER		BLUE CARE NETWORK

General Provider Information

NPI Number	:	1801880984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKLAND OPHTHALMIC SURGERY PC

Provider Business Mailing Address
First Line	:	800 S ADAMS RD
Second Line	:	SUITE 201
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-7005
Country	:	US
Telephone Number	:	248-644-8060
Fax Number	:	248-644-5081

Provider Business Practice Location Address
First Line	:	800 S ADAMS RD
Second Line	:	SUITE 201
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-7005
Country	:	US
Telephone Number	:	248-644-8060
Fax Number	:	248-644-5081

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH PRAVOOT GIRA
Credential	:
Telephone Number	:	314-909-0633

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	01/04/2024

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