Matthew Black, OD
Individual provider Active NPI Optometrist · Comstock Park, MI
NPI 1124512447 · NPPES record last updated Sep 8, 2020
Key facts
- NPI
- 1124512447
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 4901005112 (MI)
- Practice address
- 3901 Alpine Ave NW
Comstock Park, MI 49321-8350 - Phone
- (616) 647-2213
- NPI assigned
- Jun 20, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Ferris State College - College of Optometry, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
88 N Main
Cedar Springs, MI 49319-5169
Phone (616) 324-0141
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 |
|---|---|---|---|---|
| I20180627000095 | MI | Practitioner - Optometry | 4284989674 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901005112 | MI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| White Pine Eyecare PLLC | Optometrist | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901005112 | MI | Yes |
Addresses
Primary practice location
3901 Alpine Ave NW
Comstock Park, MI 49321-8350
Mailing address
3901 Alpine Ave NW
Comstock Park, MI 49321-8350
Phone (616) 647-2213
Other providers in Comstock Park, MI
- Cara Ansmits
- Amanda Barry
- William Von Benson Jr.
- Mohamad G Beydoun
- Beyond Blessed Services
- Blessing Keepers Adult Living LLC
- Stephane Bohemier
- Jerry E Bowser
- Alexis Mary Brannan
- Brent Reeve PLLC
All providers in Comstock Park, MI · Optometrist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2020. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.