Organization Active NPI

Jeffrey B. Byland, O.D., P.C.

Doing business as Excellence in Vision

  • Eyewear Supplier
  • Fremont, MI
National Provider Identifier
1003997651
Registry record updated Dec 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
4901002849 Issued in MI
Legal business name
JEFFREY B. BYLAND, O.D., P.C.
Doing business as
Excellence in Vision
Practice address
103 S Division Ave
Fremont, MI 49412-1602
Phone
(231) 924-4110
Fax
(231) 924-5007
NPI assigned
Oct 18, 2006
Last updated
Dec 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2020

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

Authorized official

Name
Dr. Lara A Eenigenburg, ODNPI 1013915859
Title
President
Phone
(231) 924-4110

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X 4901002849 MI Primary

Addresses

Primary practice location

103 S Division Ave
Fremont, MI 49412-1602

Mailing address

103 S Division Ave
Fremont, MI 49412-1602
Phone (231) 924-4110

Other identifiers 3

IdentifierTypeStateIssuer
900F26506OtherMIBC BS OF MI
410014405OtherMIMEDICARE RAILROAD
2892598MedicaidMI

Other names 1

  • EXCELLENCE IN VISION Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031218000423 MI Part B Supplier - Clinic/Group Practice 3375440118 Receives reassigned benefits from 6 practitioners
Practice locations: Fremont, MI

National Provider Directory

National Provider Directory

Locations

103 S Division Ave
Fremont, MI 49412
Phone (231) 924-0430

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607212800000",
    "number": "1003997651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 S DIVISION AVE",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "494121602",
            "telephone_number": "231-924-4110",
            "fax_number": "231-924-5007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 S DIVISION AVE",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "494121602",
            "telephone_number": "231-924-4110",
            "fax_number": "231-924-5007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY B. BYLAND, O.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-12-06",
        "certification_date": "2020-12-06",
        "status": "A",
        "authorized_official_last_name": "EENIGENBURG",
        "authorized_official_first_name": "LARA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-924-4110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MI",
            "license": "4901002849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS OF MI",
            "identifier": "900F26506",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "410014405",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2892598",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EXCELLENCE IN VISION",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fremont, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.