Provider Demographics
NPI:1104081819
Name:BLUE WATER EYE CARE ASSOCIATES PC
Entity type:Organization
Organization Name:BLUE WATER EYE CARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:KATY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROCHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-982-1300
Mailing Address - Street 1:2609 ELECTRIC AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6589
Mailing Address - Country:US
Mailing Address - Phone:810-982-1300
Mailing Address - Fax:810-982-9802
Practice Address - Street 1:2609 ELECTRIC AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6589
Practice Address - Country:US
Practice Address - Phone:810-982-1300
Practice Address - Fax:810-982-9802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty