Healthcare Provider Details

I. General information

NPI: 1346438199
Provider Name (Legal Business Name): EYE CARE SPECIALISTS OF MICHIGAN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2489 TRAUTNER DR
SAGINAW MI
48604-9596
US

IV. Provider business mailing address

2489 TRAUTNER DR
SAGINAW MI
48604-9596
US

V. Phone/Fax

Practice location:
  • Phone: 989-791-2020
  • Fax: 989-791-2083
Mailing address:
  • Phone: 989-791-2020
  • Fax: 989-791-2083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. USHA KURUMETY BULUSU
Title or Position: OWNER
Credential: MD
Phone: 989-791-2020