Healthcare Provider Details

I. General information

NPI: 1801977202
Provider Name (Legal Business Name): BLUE SKY VISION EYE CARE, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 EAST BELTLINE NE
GRAND RAPIDS MI
49525-6049
US

IV. Provider business mailing address

750 E BELTLINE AVE NE
GRAND RAPIDS MI
49525-6049
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-2600
  • Fax: 616-954-0213
Mailing address:
  • Phone: 616-949-2600
  • Fax: 616-954-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH GIRA
Title or Position: CMO
Credential: MD
Phone: 636-200-4393