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General NPI Number Information
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NPI Number | 1881731248
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Entity Type | Organization
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Legal Business Name | NORTH BAY OPHTHALMOLOGY, PC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 01/10/2008
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Provider Practice Location Address
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Address Line | 2061 M 119
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City | PETOSKEY
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State | MI
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Zip | 49770-8914
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Country | US
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Telephone | 231-487-2020
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Fax | 231-487-6166
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Provider Business Mailing Address
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Address Line | 2061 M 119
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City | PETOSKEY
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State | MI
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Zip | 49770-8914
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Country | US
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Telephone | 231-487-2020
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Fax | 231-487-6166
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Authorized Official
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Title or Position | PRESIDENT,OWNER
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Name | TIMOTHY VAN EVERY
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Credential | M.D.
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Telephone | 231-487-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | TV039837
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License Number State | MI
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