Provider Demographics
NPI:1285854000
Name:GOSSAGE EYE INSTITUTE, PLC
Entity Type:Organization
Organization Name:GOSSAGE EYE INSTITUTE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOSSAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-439-2020
Mailing Address - Street 1:50 W CARLETON RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1202
Mailing Address - Country:US
Mailing Address - Phone:517-439-2020
Mailing Address - Fax:517-437-5577
Practice Address - Street 1:50 W CARLETON RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1202
Practice Address - Country:US
Practice Address - Phone:517-439-2020
Practice Address - Fax:517-437-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4495541Medicaid
MI4247015Medicaid
MI4696989Medicaid
MI5624720001Medicare NSC
0N64420Medicare PIN
MIDA1206Medicare PIN