Individual provider Active NPI

Angelo Tocco, O.D.

  • Optometrist
  • Grosse Pointe, MI
National Provider Identifier
1043380553
Registry record updated Apr 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901002831 Issued in MI
Practice address
20845 Mack Ave
Grosse Pointe, MI 48236-1456
Phone
(313) 885-4987
Fax
(313) 885-4198
NPI assigned
Nov 9, 2006
Last updated
Apr 9, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2009

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901002831 MI Primary
Corneal and Contact Management Optometrist 152WC0802X 4901002831 MI
Pediatric Optometrist 152WP0200X 4901002831 MI
Sports Vision Optometrist 152WS0006X 4901002831 MI

Addresses

Primary practice location

20845 Mack Ave
Grosse Pointe, MI 48236-1456

Mailing address

20845 Mack Ave
Grosse Pointe, MI 48236-1456
Phone (313) 885-4987

Other identifiers 1

IdentifierTypeStateIssuer
382191872MedicaidMI

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20071005000758 MI Practitioner - Optometry 0749375665

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4901002831MIMDPediatric Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Eye Specialists of Troy, PC Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239235200000",
    "number": "1043380553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20845 MACK AVE",
            "city": "GROSSE POINTE",
            "state": "MI",
            "postal_code": "482361456",
            "telephone_number": "313-885-4987",
            "fax_number": "313-885-4198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20845 MACK AVE",
            "city": "GROSSE POINTE",
            "state": "MI",
            "postal_code": "482361456",
            "telephone_number": "313-885-4987",
            "fax_number": "313-885-4198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOCCO",
        "first_name": "ANGELO",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2009-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901002831",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MI",
            "license": "4901002831",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "MI",
            "license": "4901002831",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "MI",
            "license": "4901002831",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "382191872",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grosse Pointe, MI

Sources for this page

Verify at the official NPI Registry.