Provider Demographics
NPI:1891013041
Name:WESTERN UPPER MICHIGAN EYE CARE LLC
Entity Type:Organization
Organization Name:WESTERN UPPER MICHIGAN EYE CARE LLC
Other - Org Name:IRON COUNTY EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD OF MANAGERS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOFFNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-932-2525
Mailing Address - Street 1:N10561 GRANDVIEW LN
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-9622
Mailing Address - Country:US
Mailing Address - Phone:906-932-2525
Mailing Address - Fax:906-932-1921
Practice Address - Street 1:131 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935-1436
Practice Address - Country:US
Practice Address - Phone:906-265-9931
Practice Address - Fax:906-265-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty