NPIMap

Organization Active NPI

Michigan Street Optical

  • Durable Medical Equipment & Medical Supplies
  • Grand Rapids, MI
National Provider Identifier
1043350689
Registry record updated Jul 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
4301030073 Issued in MI
Legal business name
MICHIGAN STREET OPTICAL
Practice address
426 Michigan St NE
Suite 101
Grand Rapids, MI 49503-5609
Phone
(616) 459-1844
Fax
(616) 459-3716
NPI assigned
Feb 6, 2007
Last updated
Jul 29, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2008

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

Authorized official

Name
Dr. Richard H Benninger, MDNPI 1275530909
Title
Owner
Phone
(269) 373-8878

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
Durable Medical Equipment & Medical Supplies 332B00000X 4301030073 MI Primary

Addresses

Primary practice location

426 Michigan St NE
Suite 101
Grand Rapids, MI 49503-5609

Mailing address

PO Box 2588
Portage, MI 49081-2588
Phone (269) 373-8878

Other identifiers 1

IdentifierTypeStateIssuer
540D116620OtherMIBLUE CROSS BLUE SHEILD

National Provider Directory

National Provider Directory

Locations

833 Michigan St NE
Ste 101
Grand Rapids, MI 49503
Phone (616) 459-1844

Practitioners & affiliated clinicians

Practitioners 10

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": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217289600000",
    "number": "1043350689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2588",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490812588",
            "telephone_number": "269-373-8878",
            "fax_number": "269-373-4720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "426 MICHIGAN ST NE",
            "address_2": "SUITE 101",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035609",
            "telephone_number": "616-459-1844",
            "fax_number": "616-459-3716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN STREET OPTICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2008-07-29",
        "status": "A",
        "authorized_official_last_name": "BENNINGER",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-373-8878",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "4301030073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "540D116620",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2008; 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.