South Haven Eyecare Associates

Primary specialty

OptometristTaxonomy code 152W00000X

License

490100 Issued in MI

Legal business name

SOUTH HAVEN EYECARE ASSOCIATES

Practice address

1088 S Bailey Ave
Suite B
South Haven, MI 49090-6723

Phone

(269) 637-1442

Fax

(269) 637-3801

NPI assigned

Mar 6, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Alice M Bacak, O.D.NPI 1669470159

Title

General Partner

Phone

(269) 637-1442

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alice Marie Bacak, O.D.

  • Optometrist
  • South Haven, MI
  • NPI 1669470159
  Medicare reassignment Care Compare group NPD Authorized official
• John A Mannik, O.D.

  • Optometrist
  • South Haven, MI
  • NPI 1003814500
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288569600000",
    "number": "1083744379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1088 BAILEY AVE",
            "address_2": "SUITE B",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490906723",
            "telephone_number": "269-637-1442",
            "fax_number": "269-637-3801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1088 S BAILEY AVE",
            "address_2": "SUITE B",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490906723",
            "telephone_number": "269-637-1442",
            "fax_number": "269-637-3801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH HAVEN EYECARE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2010-11-01",
        "status": "A",
        "authorized_official_last_name": "BACAK",
        "authorized_official_first_name": "ALICE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "GENERAL PARTNER",
        "authorized_official_telephone_number": "269-637-1442",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "490100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0H07612",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alisa A Somers, DPT
• South Coast Home LLC
• South Haven Area Emergency Services Authority
• South Haven Chiropractic Clinic
• South Haven Community Health System
• South Haven Family Physicians, P.C.
• South Haven Opco, LLC
• Southwest Family Footcare Specialist, LLC
• Regina Lynne Spears, D.P.M.
• Spectrum Health Primary Care Partners

• Optometrist in South Haven, MI
• Providers in South Haven, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.