Provider Demographics
NPI:1578690707
Name:EYE CARE ASSOCIATES OF OWOSSO, P.C.
Entity Type:Organization
Organization Name:EYE CARE ASSOCIATES OF OWOSSO, P.C.
Other - Org Name:DRS. BALL, SEELYE, & MAKI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MAKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:989-723-1101
Mailing Address - Street 1:317 S ELM ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2636
Mailing Address - Country:US
Mailing Address - Phone:989-723-1101
Mailing Address - Fax:989-723-1665
Practice Address - Street 1:317 S ELM ST
Practice Address - Street 2:SUITE 210
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2636
Practice Address - Country:US
Practice Address - Phone:989-723-1101
Practice Address - Fax:989-723-1665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1699252Medicaid
MI1699261Medicaid
MI4723404Medicaid
MIT71109Medicare UPIN
MIU28861Medicare UPIN
MIU25856Medicare UPIN
MI4723404Medicaid
MI0G87609001Medicare PIN
MI0G87609002Medicare PIN
MI0G87609004Medicare PIN