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

Last updated

Apr 5, 2021By the provider in NPPES

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Myeyedr Optometry of Michigan, LLC

  dba MyEyeDr.

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

  dba MyEyeDr.

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

  dba RX Optical

  • 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. (Strikwerda Family Dentistry)
• James T. Bishop, M.D., P.C. (New Health Medical)
• 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.