Provider Demographics
NPI:1801880984
Name:OAKLAND OPHTHALMIC SURGERY PC
Entity type:Organization
Organization Name:OAKLAND OPHTHALMIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PRAVOOT
Authorized Official - Last Name:GIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-909-0633
Mailing Address - Street 1:800 S ADAMS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-7005
Mailing Address - Country:US
Mailing Address - Phone:248-644-8060
Mailing Address - Fax:248-644-5081
Practice Address - Street 1:800 S ADAMS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-7005
Practice Address - Country:US
Practice Address - Phone:248-644-8060
Practice Address - Fax:248-644-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0F37296OtherBCBSM
180F372960OtherBLUE CARE NETWORK
=========OtherPPOM
=========OtherGREATLAKES
=========OtherAETNA
=========OtherUNITED HEALTHCARE
=========OtherWPS TRICARE FOR LIFE
=========OtherHARRINGTON BENEFITS
0F37296OtherBCBSM
=========OtherGREAT LAKES
=========OtherGREATLAKES
=========OtherWPS TRICARE FOR LIFE
MI0F37296Medicare ID - Type Unspecified