Individual provider Active NPI

Kristina Atleski

  • Optometrist
  • Mount Clemens, MI
National Provider Identifier
1063244200
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901005833 Issued in MI
Practice address
118 Cass Ave
Mount Clemens, MI 48043-2204
Phone
(586) 468-7612
NPI assigned
Aug 16, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901005833 MI Primary

Addresses

Primary practice location

118 Cass Ave
Mount Clemens, MI 48043-2204

Mailing address

52868 Kelly Dr
Macomb, MI 48042-5610
Phone (586) 484-5513

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
I20250207000936 MI Practitioner - Optometry 0547792392 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
SVS Vision Inc Optometrist CurrentSince Dec 5, 2024 Accepting new patients
SVS Vision Inc Optometrist CurrentSince Dec 5, 2024 Accepting new patients

Locations

455 E Grand River Ave
Brighton, MI 48116
Phone (810) 227-2376

36383 26 Mile Rd
Lenox, MI 48048
Phone (586) 648-5990

118 Cass Ave
Mount Clemens, MI 48043
Phone (586) 464-1479

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1723766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1063244200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52868 KELLY DR",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480425610",
            "telephone_number": "586-484-5513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 CASS AVE",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432204",
            "telephone_number": "586-468-7612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATLESKI",
        "first_name": "KRISTINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-16",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901005833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Clemens, MI

Sources for this page

Verify at the official NPI Registry.