NPIMap

Organization Active NPI

P-Cor LLC

Doing business as Henry Ford Optimeyes

  • Optometrist
  • Plymouth, MI
National Provider Identifier
1104571074
Registry record updated Feb 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
P-COR LLC
Doing business as
Henry Ford Optimeyes
Practice address
40895 Ann Arbor Rd
Plymouth, MI 48170
Phone
(734) 233-6300
NPI assigned
Feb 18, 2022
Last updated
Feb 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2022

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

Authorized official

Name
Shakia Tisdale
Title
Credentialing/Privileging
Phone
(248) 577-3659

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

40895 Ann Arbor Rd
Plymouth, MI 48170

Mailing address

735 John R Rd Ste 150
Troy, MI 48083-5859
Phone (248) 588-9300

Other names 1

  • HENRY FORD OPTIMEYES Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220511001797 MI DME Supplier - Physician - Optometrist 9931194149 Practice locations: Plymouth, MI

Other NPIs with the same Medicare PAC ID 22

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 22

Laboratory certificates & supplier records

Derived by NPIMap

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

SupplierSuppliesMedicare assignment
P-Cor LLC40895 Ann Arbor Rd E, Plymouth, MI 48170-4448(734) 233-6300 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 1997

National Provider Directory

National Provider Directory
Tax ID family
Pcor - LLC26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 87

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 87

NPI Registry JSON

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

{
    "created_epoch": "1645142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645142400000",
    "number": "1104571074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 JOHN R RD STE 150",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480835859",
            "telephone_number": "248-588-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40895 ANN ARBOR RD",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "48170",
            "telephone_number": "734-233-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P-COR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-18",
        "last_updated": "2022-02-18",
        "certification_date": "2022-02-04",
        "status": "A",
        "authorized_official_last_name": "TISDALE",
        "authorized_official_first_name": "SHAKIA",
        "authorized_official_title_or_position": "CREDENTIALING/PRIVILEGING",
        "authorized_official_telephone_number": "248-577-3659"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HENRY FORD OPTIMEYES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plymouth, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2022; 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.