Healthcare Provider Details

I. General information

NPI: 1891013041
Provider Name (Legal Business Name): WESTERN UPPER MICHIGAN EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W GENESEE ST
IRON RIVER MI
49935-1436
US

IV. Provider business mailing address

N10561 GRANDVIEW LN
IRONWOOD MI
49938-9622
US

V. Phone/Fax

Practice location:
  • Phone: 906-265-9931
  • Fax: 906-265-6202
Mailing address:
  • Phone: 906-932-2525
  • Fax: 906-932-1921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROL A GOFFNETT
Title or Position: BOARD OF MANAGERS
Credential:
Phone: 906-932-2525