Individual provider Active NPI

Douglas Arthur Coon, O.D.

  • Optometrist
  • Wyoming, MI
National Provider Identifier
1144246356
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901004095 Issued in MI
Practice address
5838 Metro Way SW
Wyoming, MI 49519-9619
Phone
(616) 249-5300
NPI assigned
Jul 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901004095 MI Primary

Addresses

Primary practice location

5838 Metro Way SW
Wyoming, MI 49519-9619

Mailing address

5838 Metro Way SW
Wyoming, MI 49519-9619
Phone (616) 249-5300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20130408000400 MI Order and Referring Only - OptometryPractitioner - Optometry 8527203918

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4901004095MIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Battle Creek Vamc CurrentSince Nov 5, 2023 Accepting new patients

Locations

5838 Metro Way SW
Wyoming, MI 49519
Phone (616) 249-5300

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1144246356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5838 METRO WAY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199619",
            "telephone_number": "616-249-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5838 METRO WAY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199619",
            "telephone_number": "616-249-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COON",
        "first_name": "DOUGLAS",
        "middle_name": "ARTHUR",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MI

Sources for this page

Verify at the official NPI Registry.