Provider Demographics
NPI:1679739114
Name:PASQUA LLC
Entity type:Organization
Organization Name:PASQUA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMMASINA
Authorized Official - Middle Name:PASQUA
Authorized Official - Last Name:DARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:989-724-7440
Mailing Address - Street 1:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48740-0563
Mailing Address - Country:US
Mailing Address - Phone:989-362-3478
Mailing Address - Fax:989-362-2380
Practice Address - Street 1:1704 E US 23
Practice Address - Street 2:
Practice Address - City:EAST TAWAS
Practice Address - State:MI
Practice Address - Zip Code:48730-9329
Practice Address - Country:US
Practice Address - Phone:989-362-3478
Practice Address - Fax:989-362-2380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003704152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900C510530OtherBLUE CROSS BLUE SHIELD
MI900C510530OtherBLUE CROSS BLUE SHIELD
MI6150390006Medicare NSC