Mac Optical

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901003723 Issued in MI

Legal business name

MAC OPTICAL

Practice address

1425 N Leroy St
Fenton, MI 48430-2763

Phone

(810) 629-2041

Fax

(810) 629-9366

NPI assigned

Oct 1, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Denise Marie Hendricks

Title

Office Administrator

Phone

(248) 887-4861

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Diamond Optical Care Doing business as

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

{
    "created_epoch": "1191196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205366400000",
    "number": "1114114428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 N LEROY ST",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484302763",
            "telephone_number": "810-629-2041",
            "fax_number": "810-629-9366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 N LEROY ST",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484302763",
            "telephone_number": "810-629-2041",
            "fax_number": "810-629-9366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAC OPTICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-01",
        "last_updated": "2008-03-13",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "248-887-4861",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0B51128",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "900B51128",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP",
            "identifier": "0N11050",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3442884",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diamond Optical Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lorday Systems, Inc.
• Hayley Lubinski, LLMSW
• Marta Elizabeth Lundquist-Shaw
• Kathryn Luther, DPT
• Suzanne Lynch
• Mac Optical
• Tammy Mackenzie
• Kaelin Magrath, PA-C
• David Alan Mahan, BCHIS
• Hillary Margaret May Maier, LPC

• Optometrist in Fenton, MI
• Providers in Fenton, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.