Provider Demographics
NPI:1225616279
Name:TRAVERSE CITY OPHTHALMOLOGY PLLC
Entity Type:Organization
Organization Name:TRAVERSE CITY OPHTHALMOLOGY PLLC
Other - Org Name:TRAVERSE CITY EYE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCAHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-935-8101
Mailing Address - Street 1:5199 N ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-9201
Mailing Address - Country:US
Mailing Address - Phone:231-935-8101
Mailing Address - Fax:
Practice Address - Street 1:3830 W FRONT ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-8153
Practice Address - Country:US
Practice Address - Phone:231-935-8101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty