MEDICARE: BELILL EYE CARE, PLC.

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	4901004242	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	900B513980	OTHER		BCBS OF MI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538101332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELILL EYE CARE, PLC.

Provider Business Mailing Address
First Line	:	5092 W VIENNA RD
Second Line	:	SUITE I
City	:	CLIO
State	:	MI
Zip	:	48420-2803
Country	:	US
Telephone Number	:	810-564-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5092 W VIENNA RD
Second Line	:	SUITE I
City	:	CLIO
State	:	MI
Zip	:	48420-2803
Country	:	US
Telephone Number	:	810-564-2000
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	DR. NICHOLAS MICHAEL BELILL
Credential	:	O.D.
Telephone Number	:	810-564-2000

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	05/30/2013

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