Organization
NORTHERN EYE CARE ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEAU DAVID POQUETTE O.D. (OPTOMETRIST)
(906) 774-8280
Entity
Organization
Contact information
Practice address
200 FAIRBANKS ST, IRON MOUNTAIN, MI 49801-1510
(906) 774-8280
(906) 774-8290
Mailing address
200 FAIRBANKS ST, IRON MOUNTAIN, MI 49801-1510
(906) 774-8280
(906) 774-8290
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004595
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0B20055
BCBSM
MI
01
—
6891720001
MEDICARE DMEPOS
MI
Enumeration date
10/27/2011
Last updated
11/23/2016
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