Active NPI
Robert Guy Farrell Jr., O.D.
- Optometrist
- Mount Clemens, MI
National Provider Identifier
1104993823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901003307
- Practice address
- 140 Macomb PL
Mount Clemens, MI 48043-5651 - Phone
- (586) 322-1875
- NPI assigned
- Nov 29, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901003307 | MI | Primary |
Addresses
Primary practice location
140 Macomb PL
Mount Clemens, MI 48043-5651
Mailing address
1280 Pine Dr
Ortonville, MI 48462-8850
Phone (586) 322-1875
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SVS Vision Inc | Optometrist | Current | Accepting new patients |
| SVS Vision Inc | Optometrist | Current | Accepting new patients |
| SVS Vision Inc | Optometrist | Past | Accepting new patients |
| SVS Vision Inc | Optometrist | Past | Accepting new patients |
Locations
3192 S Linden Rd
Ste B121
Flint, MI 48507
Phone (810) 230-9300
118 Cass Ave
Mount Clemens, MI 48043
Phone (586) 464-1479
140 Macomb Pl
Mount Clemens, MI 48043
Phone (586) 464-1479
Organizations & group practices 5
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.
-
- Optometrist
- Mount Clemens, MI
- NPI 1194879023
-
- Optometrist
- Lake Orion, MI
- NPI 1972638914
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104993823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1280 PINE DR",
"city": "ORTONVILLE",
"state": "MI",
"postal_code": "484628850",
"telephone_number": "586-322-1875"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 MACOMB PL",
"city": "MOUNT CLEMENS",
"state": "MI",
"postal_code": "480435651",
"telephone_number": "586-322-1875"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARRELL",
"first_name": "ROBERT",
"middle_name": "GUY",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901003307",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Clemens, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.