=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679595201
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAY EYE CARE CENTER, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2006
-----------------------------------------------------
Last Update Date | 06/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 N TUSCOLA RD
-----------------------------------------------------
City | BAY CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48708-6961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-892-9595
-----------------------------------------------------
Fax | 989-892-3080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 N TUSCOLA RD
-----------------------------------------------------
City | BAY CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48708-6961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-892-9595
-----------------------------------------------------
Fax | 989-892-3080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERVISOR
-----------------------------------------------------
Name | ANDREA NICOLE CLARK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 989-892-9595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------