Provider Demographics
NPI:1538101332
Name:BELILL EYE CARE, PLC.
Entity Type:Organization
Organization Name:BELILL EYE CARE, PLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BELILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-564-2000
Mailing Address - Street 1:5092 W VIENNA RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-2803
Mailing Address - Country:US
Mailing Address - Phone:810-564-2000
Mailing Address - Fax:
Practice Address - Street 1:5092 W VIENNA RD
Practice Address - Street 2:SUITE I
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-2803
Practice Address - Country:US
Practice Address - Phone:810-564-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004242152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
900B513980OtherBCBS OF MI
MI94-4839830Medicaid
900B513980OtherBCBS OF MI
MI0P28570Medicare PIN
MI5729410001Medicare NSC