Teresa Marie Ennis-Decker, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901003316 Issued in MI

Practice address

9575 State Rd
Millington, MI 48746-9482

Phone

(989) 871-9552

Fax

(989) 871-9554

NPI assigned

Aug 3, 2005

Reactivated

Mar 29, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Lakeville Eye Care Center, Inc.

  • Optometrist
  • Millington, MI
  • NPI 1770526436
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341273600000",
    "number": "1154322956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9575 STATE RD",
            "city": "MILLINGTON",
            "state": "MI",
            "postal_code": "487469482",
            "telephone_number": "989-871-9552",
            "fax_number": "989-871-9554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9575 STATE RD",
            "city": "MILLINGTON",
            "state": "MI",
            "postal_code": "487469482",
            "telephone_number": "989-871-9552",
            "fax_number": "989-871-9554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENNIS-DECKER",
        "first_name": "TERESA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-03",
        "last_updated": "2012-07-03",
        "deactivation_date": "2006-03-21",
        "reactivation_date": "2006-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4743819",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tammy Joette Birkenmeier, MA, LLFMT
• Amanda Renee Bishop, LLPC
• Sondra R Bolzman, MIDWIFE CPM
• Tamara Bukoski
• Timothy Patrick Carney, D.D.S.
• Laura Ewald
• Raeann Henderson
• Sandra Hurst, MBA LBSW
• Marie E Kenny, DO
• Shianne Kozma, CST, FA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.