Provider Demographics
NPI:1497792386
Name:UP OPHTHALMOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:UP OPHTHALMOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GERSICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-786-5181
Mailing Address - Street 1:1015 S LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-2100
Mailing Address - Country:US
Mailing Address - Phone:906-786-5181
Mailing Address - Fax:
Practice Address - Street 1:1015 S LINCOLN RD
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-2100
Practice Address - Country:US
Practice Address - Phone:906-786-5181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1659572071Medicaid
MI180B160140OtherBLUE CROSS BLUE SHIELD
MI102758320Medicaid
MI102940677Medicaid
MI0150880001Medicare PIN
MI0B16014Medicare PIN
MICM1588Medicare PIN