MEDICARE: NORTHERN VISION EYE CARE, PC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CG7309	OTHER	MI	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1801998182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN VISION EYE CARE, PC

Provider Business Mailing Address
First Line	:	PO BOX 1907
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49685-1907
Country	:	US
Telephone Number	:	231-932-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4033 EASTER SKY DRIVE
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684
Country	:	US
Telephone Number	:	231-932-9000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT K BUTRYN II
Credential	:	MD
Telephone Number	:	231-932-9000

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	06/23/2008

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