Active NPI
Jartll Corp
- Optometrist
- Detroit, MI
National Provider Identifier
1124179346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- Legal business name
- JARTLL CORP
- Practice address
- 15336 Grand River Ave
Detroit, MI 48227-2215 - Phone
- (313) 836-1666
- Fax
- (313) 836-1066
- NPI assigned
- Jan 15, 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
- Heather M Kingery
- Title
- Insurance Supervisor
- Phone
- (238) 871-1234
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | Primary |
Addresses
Primary practice location
15336 Grand River Ave
Detroit, MI 48227-2215
Mailing address
15336 Grand River Ave
Detroit, MI 48227-2215
Phone (313) 836-1666
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124179346 | Medicaid | MI |
Other names 1
- OPTICAL WORLD
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070503000237 | MI | Part B Supplier - Clinic/Group Practice | 3274639596 |
Receives reassigned benefits from 8 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Auburn Hills, MI; Bloomfield Hills, MI; Detroit, MI; Rochester, MI |
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- Jartll Corp
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Optometrist
- Auburn Hills, MI
- NPI 1548311756
-
- Optometrist
- Rochester, MI
- NPI 1932250156
-
- Optometrist
- Southfield, MI
- NPI 1952420267
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168819200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1328572800000",
"number": "1124179346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15336 GRAND RIVER AVE",
"city": "DETROIT",
"state": "MI",
"postal_code": "482272215",
"telephone_number": "313-836-1666",
"fax_number": "313-836-1066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15336 GRAND RIVER AVE",
"city": "DETROIT",
"state": "MI",
"postal_code": "482272215",
"telephone_number": "313-836-1666",
"fax_number": "313-836-1066"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JARTLL CORP",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-15",
"last_updated": "2012-02-07",
"status": "A",
"authorized_official_last_name": "KINGERY",
"authorized_official_first_name": "HEATHER",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "INSURANCE SUPERVISOR",
"authorized_official_telephone_number": "238-871-1234"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1124179346",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "OPTICAL WORLD",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.