Provider Demographics
NPI:1679516447
Name:BELILL, NICHOLAS MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:MICHAEL
Last Name:BELILL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5092 W VIENNA RD STE I
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-2804
Mailing Address - Country:US
Mailing Address - Phone:810-564-2000
Mailing Address - Fax:810-564-2226
Practice Address - Street 1:5092 W VIENNA RD STE I
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-2804
Practice Address - Country:US
Practice Address - Phone:810-564-2000
Practice Address - Fax:810-564-2226
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004242152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI94 4839830Medicaid
MINB004242OtherBCBS
MIP28570001Medicare PIN
MI5729410001Medicare NSC