Healthcare Provider Details

I. General information

NPI: 1922735752
Provider Name (Legal Business Name): BLUE SKY VISION EYE CARE, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5477 W CLARK RD
YPSILANTI MI
48197-1102
US

IV. Provider business mailing address

5477 W CLARK RD
YPSILANTI MI
48197-1102
US

V. Phone/Fax

Practice location:
  • Phone: 734-434-6000
  • Fax: 734-434-7005
Mailing address:
  • Phone: 734-434-6000
  • Fax: 734-434-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH PRAVOOT GIRA
Title or Position: CMO
Credential: MD
Phone: 314-909-0633