MEDICARE: OPHTHALMOLOGY AQUISITION 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	207W00000X	Ophthalmology Physician		MI

General Provider Information

NPI Number	:	1730353335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPHTHALMOLOGY AQUISITION PLC

Provider Business Mailing Address
First Line	:	36821 GREEN ST
Second Line	:
City	:	NEW BALTIMORE
State	:	MI
Zip	:	48047-1607
Country	:	US
Telephone Number	:	586-716-0538
Fax Number	:

Provider Business Practice Location Address
First Line	:	36821 GREEN ST
Second Line	:
City	:	NEW BALTIMORE
State	:	MI
Zip	:	48047-1607
Country	:	US
Telephone Number	:	586-716-0538
Fax Number	:

Authorized Official
Title or Position	:	BILLING
Name	:	KATHY HUBCHIK
Credential	:
Telephone Number	:	734-207-1690

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	02/05/2014

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