Blaze Sammon, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901005661 Issued in MI

Practice address

W8159 S US Highway 2/141 Ste 102
Iron Mountain, MI 49801-9423

Phone

(906) 779-9164

Fax

(906) 774-5547

NPI assigned

Aug 8, 2022

Last updated

Oct 16, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialty

Optometry

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shoptikal LLCGroup PAC ID 1456684471, 192 clinicians

Practice addresses (Care Compare)

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.

• Shoptikal LLC

  dba Shopko Optical 4010

  • Eyewear Supplier
  • Marquette, MI
  • NPI 1578129094

  Optometrist

  Medicare reassignment Care Compare group NPD
• Shoptikal LLC

  dba Shopko Optical 4016

  • Eyewear Supplier
  • Escanaba, MI
  • NPI 1598321911

  Optometrist

  NPD
• Shoptikal LLC

  dba Shopko Optical 4011

  • Eyewear Supplier
  • Iron Mountain, MI
  • NPI 1831755255

  Optometrist

  NPD
• Shoptikal LLC

  dba Fielmann Vision Care 4313

  • Eyewear Supplier
  • Rockford, IL
  • NPI 1467311142

  Optometrist

  NPD
• Shoptikal LLC

  dba Shopko Optical 4002

  • Eyewear Supplier
  • Green Bay, WI
  • NPI 1659937159

  Optometrist

  NPD
• Shoptikal LLC

  dba Shopko Optical 4028

  • Eyewear Supplier
  • Appleton, WI
  • NPI 1982260352

  Optometrist

  NPD
• Shoptikal LLC

  dba Shopko Optical 4066

  • Eyewear Supplier
  • Spokane, WA
  • NPI 1154987535

  Optometrist

  NPD (past)
• Shoptikal LLC

  dba Shopko Optical 4177

  • Eyewear Supplier
  • Green Bay, WI
  • NPI 1194381509

  Optometrist

  NPD (past)

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

{
    "created_epoch": "1659916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760572800000",
    "number": "1093442121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W1974 BEAVER PETE RD",
            "city": "VULCAN",
            "state": "MI",
            "postal_code": "498928226",
            "telephone_number": "616-710-9939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W8159 S US HIGHWAY 2/141 STE 102",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498019423",
            "telephone_number": "906-779-9164",
            "fax_number": "906-774-5547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMMON",
        "first_name": "BLAZE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-08",
        "last_updated": "2025-10-16",
        "certification_date": "2025-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901005661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derrick Bert Ruohomaki, PHARMD
• Michelle Anne Ruth, RRT
• Adam Paul Ryan, M.D.
• Terence D Ryan, MD
• Kylie Ann Sabol
• Jaime Allan Santi
• Douglas C Sauter, M.D.
• Robert G. Scharffenberg, M.D.
• Madison Scheriff, RN
• Amy L Schewe

• Optometrist in Iron Mountain, MI
• Providers in Iron Mountain, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2025; 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.
• 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.