Healthcare Provider Details

I. General information

NPI: 1487664546
Provider Name (Legal Business Name): U P EYE SPECIALISTS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE SUITE 347
MARQUETTE MI
49855
US

IV. Provider business mailing address

1414 W FAIR AVE SUITE 347
MARQUETTE MI
49855
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-4512
  • Fax: 906-225-4514
Mailing address:
  • Phone: 906-225-4512
  • Fax: 906-225-4514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK W ULRICKSON
Title or Position: OWNER PARTNER
Credential: DO PC
Phone: 906-225-4512