Provider Demographics
NPI:1982009601
Name:WESTSIDE EYE CARE, PC
Entity Type:Organization
Organization Name:WESTSIDE EYE CARE, PC
Other - Org Name:MARSHALL EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FITZMAURICE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:586-350-3141
Mailing Address - Street 1:14915 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-8504
Mailing Address - Country:US
Mailing Address - Phone:269-781-9863
Mailing Address - Fax:269-781-8964
Practice Address - Street 1:14915 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-8504
Practice Address - Country:US
Practice Address - Phone:269-781-9863
Practice Address - Fax:269-781-8964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI05968U152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7467500001Medicare PIN
MI7467500001Medicare NSC