Healthcare Provider Details

I. General information

NPI: 1801880984
Provider Name (Legal Business Name): OAKLAND OPHTHALMIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S ADAMS RD SUITE 201
BIRMINGHAM MI
48009-7005
US

IV. Provider business mailing address

800 S ADAMS RD SUITE 201
BIRMINGHAM MI
48009-7005
US

V. Phone/Fax

Practice location:
  • Phone: 248-644-8060
  • Fax: 248-644-5081
Mailing address:
  • Phone: 248-644-8060
  • Fax: 248-644-5081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: JOSEPH PRAVOOT GIRA
Title or Position: OWNER
Credential:
Phone: 314-909-0633