Provider Demographics
NPI:1487664546
Name:U P EYE SPECIALISTS PLC
Entity Type:Organization
Organization Name:U P EYE SPECIALISTS PLC
Other - Org Name:OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:ULRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO PC
Authorized Official - Phone:906-225-4512
Mailing Address - Street 1:1414 W FAIR AVE
Mailing Address - Street 2:SUITE 347
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:906-225-4512
Mailing Address - Fax:906-225-4514
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:SUITE 347
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-225-4512
Practice Address - Fax:906-225-4514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0963130002Medicare NSC
MI0963130001Medicare NSC