Healthcare Provider Details

I. General information

NPI: 1811306152
Provider Name (Legal Business Name): ELOWSKY EYECARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 S MAIN ST
CHEBOYGAN MI
49721-2220
US

IV. Provider business mailing address

730 S MAIN ST
CHEBOYGAN MI
49721-2220
US

V. Phone/Fax

Practice location:
  • Phone: 231-627-5666
  • Fax: 231-627-5487
Mailing address:
  • Phone: 231-627-5666
  • Fax: 231-627-5487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004788
License Number StateMI

VIII. Authorized Official

Name: DR. TRAVIS JAMES ELOWSKY
Title or Position: DOCTOR OF OPTOMETRY
Credential: O.D.
Phone: 989-916-5544