Lara Ann Eenigenburg, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004195 Issued in MI

Practice address

103 S Division Ave
PO Box E
Fremont, MI 49412-1602

Phone

(231) 924-4110

Fax

(231) 924-5007

NPI assigned

Jul 13, 2005

Last updated

May 21, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Ferris State College - College of Optometry, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jeffrey B Byland OD PCGroup PAC ID 3375440118, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jeffrey B. Byland, O.D., P.C.

  dba Excellence in Vision

  • Eyewear Supplier
  • Fremont, MI
  • NPI 1003997651
  Medicare reassignment Care Compare group Authorized official

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

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211328000000",
    "number": "1013915859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 S DIVISION AVE",
            "address_2": "PO BOX E",
            "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",
            "address_2": "PO BOX E",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "494121602",
            "telephone_number": "231-924-4110",
            "fax_number": "231-924-5007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EENIGENBURG",
        "first_name": "LARA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-13",
        "last_updated": "2008-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS OF MI",
            "identifier": "900F210120",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "410014405",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "4901004195",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4640938",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Elizabeth Dunn
• Bryce Charles Dunstan, DDS
• Dva Renal Healthcare Inc (Newaygo County Dialysis)
• E.C. One, PLLC (Eye Care One)
• Derek Edlund, PHARM D
• Chelsea Leigh Eglinton, RBT
• Vicky Lynn Eikenberry, COTA
• Cortney Ellis
• Charles Gerard Emond Jr., D.O.
• Jehanna Shaelah Erho, MD

• Optometrist in Fremont, MI
• Providers in Fremont, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.