Provider Demographics
NPI:1760668107
Name:BI COUNTY OPHTHALMOLOGY PC
Entity Type:Organization
Organization Name:BI COUNTY OPHTHALMOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARDELLIO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-756-5060
Mailing Address - Street 1:28001 SCHOENHERR RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4396
Mailing Address - Country:US
Mailing Address - Phone:586-756-5060
Mailing Address - Fax:586-756-9783
Practice Address - Street 1:28001 SCHOENHERR RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4396
Practice Address - Country:US
Practice Address - Phone:586-756-5060
Practice Address - Fax:586-756-9783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 207W00000X
MI005215332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI111536954Medicaid
MI0Q31916Medicare PIN
MI111536954Medicaid
MIE31565Medicare UPIN