Provider Demographics
NPI:1801998182
Name:NORTHERN VISION EYE CARE, PC
Entity type:Organization
Organization Name:NORTHERN VISION EYE CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:BUTRYN
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:231-932-9000
Mailing Address - Street 1:PO BOX 1907
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-1907
Mailing Address - Country:US
Mailing Address - Phone:231-932-9000
Mailing Address - Fax:
Practice Address - Street 1:4033 EASTER SKY DRIVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-932-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICG7309OtherRAILROAD MEDICARE
MI5997660001Medicare NSC