MEDICARE: UP OPTOMETRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	180B160140	OTHER	MI	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497792386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UP OPTOMETRY

Provider Business Mailing Address
First Line	:	1015 S LINCOLN RD
Second Line	:
City	:	ESCANABA
State	:	MI
Zip	:	49829-2100
Country	:	US
Telephone Number	:	906-786-5181
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 S LINCOLN RD
Second Line	:
City	:	ESCANABA
State	:	MI
Zip	:	49829-2100
Country	:	US
Telephone Number	:	906-786-5181
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CINDY J GERSICH
Credential	:
Telephone Number	:	906-786-5181

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	01/15/2025

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Directions to “UP OPTOMETRY ” Practice Location

Language	Start Address	Practice Location

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