Michael David Pickering, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

963-247T Issued in LA

Practice address

5848 Line Ave
Shreveport, LA 71106-1532

Phone

(318) 865-0017

Fax

(318) 868-4738

NPI assigned

Sep 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in LA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386201600000",
    "number": "1114022175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5848 LINE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711061532",
            "telephone_number": "318-865-0017",
            "fax_number": "318-868-4738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5848 LINE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711061532",
            "telephone_number": "318-865-0017",
            "fax_number": "318-868-4738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICKERING",
        "first_name": "MICHAEL",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2013-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "LA",
            "license": "963-247T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1362549",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "2504B",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vicki Su Pickard, M.S., P.T.
• Jalynn Mar'Dai Pickens
• Jerry Pickens, M.A.
• Somesha Wallace Pickens, M.S.
• Angela Sue Pickering
• Jade Ebonie Pickett
• Jennifer Fitzgerald Pickett, R.PH
• Joyce A Pickett, RD, LD
• Yumeaka Pickings, MS, LPC
• Brittany Pier

• Optometrist in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Optometrist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2013; 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.

Verify at the official NPI Registry.