Provider Demographics
NPI:1467625673
Name:BAYVIEW OPTICAL INC
Entity Type:Organization
Organization Name:BAYVIEW OPTICAL INC
Other - Org Name:BAYVIEW OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:BLAIZE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-482-2020
Mailing Address - Street 1:33012 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1358
Mailing Address - Country:US
Mailing Address - Phone:248-482-2020
Mailing Address - Fax:248-476-6441
Practice Address - Street 1:33012 7 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1358
Practice Address - Country:US
Practice Address - Phone:248-482-2020
Practice Address - Fax:248-476-6441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003562152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5484Medicare PIN