Katherine Reed Anderson, OD
Individual provider Active NPI Optometrist · Detroit, MI
NPI 1124500699 · NPPES record last updated Aug 31, 2018
Key facts
- NPI
- 1124500699
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 4901005157 (MI)
- Practice address
- 87 Monroe St
Detroit, MI 48226-2855 - Phone
- (313) 965-2740
- NPI assigned
- Aug 31, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191112000458 | MI | Practitioner - Optometry | 1951733070 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901005157 | MI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heritage Optical Center | Optometrist | Past | Accepting new patients |
| Heritage Optical Inc. | Optometrist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901005157 | MI | Yes |
Addresses
Primary practice location
87 Monroe St
Detroit, MI 48226-2855
Mailing address
15 E Kirby St Apt 314
Detroit, MI 48202-4039
Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 31, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.