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Organization

TAWAS BAY OPTICAL INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DANIEL C SMITH O.D. (OWNER)
(989) 362-9546
Entity
Organization

Contact information

Practice address
1691 N US 23, SUITE 2, EAST TAWAS, MI 48730
(989) 362-9546
(989) 362-9567
Mailing address
1691 N US 23, SUITE 2, EAST TAWAS, MI 48730
(989) 362-9546

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003153
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0M89210001
BCBSM MEDICARE ADVANTAGE
MI
01
1291550002
DMERC
MI
01
410046393
RAILROAD MEDICARE
MI
01
900C510060
BLUE CROSS BLUE SHIELD
MI
Enumeration date
03/21/2007
Last updated
09/15/2011
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