Kiersten Coon, O.D.

Primary specialty

Pediatric OptometristTaxonomy code 152WP0200X

License

4901004219 Issued in MI

Practice address

144 Monroe Center St NW
Grand Rapids, MI 49503-2802

Phone

(616) 459-0641

Fax

(616) 459-0621

NPI assigned

Jun 7, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Kiersten Dumler Former name

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, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family and Pediatric Eye Care PLCGroup PAC ID 3173550878, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

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

• Family & Pediatric Eye Care PLC

  • Pediatric Optometrist
  • Grand Rapids, MI
  • NPI 1417137084
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372118400000",
    "number": "1033159348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 MONROE CENTER ST NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 MONROE CENTER ST NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032802",
            "telephone_number": "616-459-0641",
            "fax_number": "616-459-0621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COON",
        "first_name": "KIERSTEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-07",
        "last_updated": "2013-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MI",
            "license": "4901004219",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "MI",
            "license": "4901004219",
            "primary": true
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "MI",
            "license": "4901004219",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4599036",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN NUMBER",
            "identifier": "900D114840",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADMINASTAR SUPPLY #",
            "identifier": "5474550001",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIERSTEN",
            "last_name": "DUMLER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Hillary Taylor Coolbaugh
• Debrielle Cooley
• Sara Cooley
• Alex T Coon, ATC
• Jill Coon, PT, DPT
• Thomas Coon
• Caitlyn Cooney, LLMSW
• Jillian Marie Coons, PHARM D
• Allison Cooper, MMSC PA-C
• Brea Cooper, BS, PTA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; 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.