Modern Optics, Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004140 Issued in MI

Legal business name

MODERN OPTICS, INC

Practice address

4228 29TH St SE
Grand Rapids, MI 49512-1936

Phone

(616) 949-5860

NPI assigned

Mar 20, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Vince Conens

Title

President

Phone

(616) 949-5860

Specialties & licenses 2

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253232000000",
    "number": "1003931601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4228 29TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495121936",
            "telephone_number": "616-949-5860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4228 29TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495121936",
            "telephone_number": "616-949-5860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN OPTICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2009-09-18",
        "status": "A",
        "authorized_official_last_name": "CONENS",
        "authorized_official_first_name": "VINCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-949-5860",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901002933",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS - EXAMS",
            "identifier": "900D11540-0",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mobile Anesthesiologists of Michigan PLLC
• Mobility Center Inc.
• Marcy Kay Mobley
• Christopher Robert Moblo, RPH
• Malina Moceri
• Modern Optics, Inc.
• Modern Periodontics
• Krishna Modi, MD
• Amy Modlin, LMSW, CAADC
• Ann Kathryn Modzeleski, LPC

• Optometrist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.