Provider Demographics
NPI:1134384936
Name:EYECARE PHYSICIANS AND SURGEONS PC
Entity type:Organization
Organization Name:EYECARE PHYSICIANS AND SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRITTSCHUH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-344-3366
Mailing Address - Street 1:4016 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2745
Mailing Address - Country:US
Mailing Address - Phone:269-344-3366
Mailing Address - Fax:269-344-3676
Practice Address - Street 1:4016 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2745
Practice Address - Country:US
Practice Address - Phone:269-344-3366
Practice Address - Fax:269-344-3676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJT031851207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0524240001Medicare NSC