Active NPI
Tawas Bay Optical Inc.
- Optometrist
- East Tawas, MI
National Provider Identifier
1104942135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901003153
- Legal business name
- TAWAS BAY OPTICAL INC.
- Practice address
- 1691 N US 23
Suite 2
East Tawas, MI 48730 - Phone
- (989) 362-9546
- Fax
- (989) 362-9567
- NPI assigned
- Mar 21, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Daniel C Smith, O.D.
- Title
- Owner
- Phone
- (989) 362-9546
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901003153 | MI | Primary |
Addresses
Primary practice location
1691 N US 23
Suite 2
East Tawas, MI 48730
Mailing address
1691 N US 23
Suite 2
East Tawas, MI 48730
Phone (989) 362-9546
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 900C510060 | Other | MI | BLUE CROSS BLUE SHIELD |
| 410046393 | Other | MI | RAILROAD MEDICARE |
| 0M89210001 | Other | MI | BCBSM MEDICARE ADVANTAGE |
| 1291550002 | Other | MI | DMERC |
National Provider Directory
National Provider DirectoryLocations
1691 E US 23
Ste 2
East Tawas, MI 48730
Phone (989) 362-9546
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174435200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1316044800000",
"number": "1104942135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1691 N US 23",
"address_2": "SUITE 2",
"city": "EAST TAWAS",
"state": "MI",
"postal_code": "48730",
"telephone_number": "989-362-9546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1691 N US 23",
"address_2": "SUITE 2",
"city": "EAST TAWAS",
"state": "MI",
"postal_code": "48730",
"telephone_number": "989-362-9546",
"fax_number": "989-362-9567"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TAWAS BAY OPTICAL INC.",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-21",
"last_updated": "2011-09-15",
"status": "A",
"authorized_official_last_name": "SMITH",
"authorized_official_first_name": "DANIEL",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "989-362-9546",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "MI",
"license": "4901003153",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "900C510060",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "410046393",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM MEDICARE ADVANTAGE",
"identifier": "0M89210001",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC",
"identifier": "1291550002",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Tawas, MI
- Michelle St. Aubin, MS, CCC-SLP
- Katherine Olivia Stepp
- Wendy S Strawn, BEHAVIOR TECHNICIAN
- Patricia Pauline Sullivan, LMSW LMFT DCSW
- Jennifer Sylvester, RN
- Andrew Rance Vanvlerah
- David Wajda, BEHAVIOR TECHNICIAN
- Lindsey Walters, BEHAVIOR TECHNICIAN
- Jamie M Watkins, BEHAVIOR TECHNICIAN
- Dianne B Webb, PHD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.