Michael P Jacquemin, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004403 Issued in MI

Practice address

12659 Riley St
Holland, MI 49424-9215

Phone

(616) 399-1440

Fax

(616) 399-2169

NPI assigned

Dec 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Myeyedr Optometry of Michigan, LLC

  • Optometrist
  • Shelby Township, MI
  • NPI 1639723596
  Medicare reassignment NPD
• Myeyedr Optometry of Michigan, LLC

  • Optometrist
  • Clarkston, MI
  • NPI 1215753553
  NPD
• Myeyedr Optometry of Michigan, LLC

  • Optometrist
  • Holland, MI
  • NPI 1710562202
  NPD

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617580800000",
    "number": "1043376726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12659 RILEY ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494249215",
            "telephone_number": "616-399-1440",
            "fax_number": "616-399-2169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACQUEMIN",
        "first_name": "MICHAEL",
        "middle_name": "P",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gloria Izurieta
• Bryan Michael Jackson
• Christine Jackson, LLPC
• Susan Jackson
• Samantha Jacobs
• Rebecca A Jacquemin, OD
• James Strikwerda D.D.S., P.C.
• James T. Bishop, M.D., P.C.
• Aimee M James, SOCIAL WORKER
• Kelly Marie James, OD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.