Provider Demographics
NPI:1972742526
Name:U P EYE SPECIALISTS PLC
Entity Type:Organization
Organization Name:U P EYE SPECIALISTS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHEARER
Authorized Official - Suffix:
Authorized Official - Credentials:MDPC
Authorized Official - Phone:906-225-4512
Mailing Address - Street 1:1414 W FAIR AVE
Mailing Address - Street 2:SUITE 347
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2675
Mailing Address - Country:US
Mailing Address - Phone:906-225-4512
Mailing Address - Fax:906-225-4514
Practice Address - Street 1:901 LAKESHORE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-1367
Practice Address - Country:US
Practice Address - Phone:906-225-4512
Practice Address - Fax:906-225-4514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
MI207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3179850Medicaid
MI1033407770Medicaid
MI2805583Medicaid
MI3122446Medicaid
MI4500051Medicaid