Spartan Eyecare, P.L.L.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004432 Issued in MI

Legal business name

SPARTAN EYECARE, P.L.L.C.

Practice address

4573 Willoughby Rd Ste D
Holt, MI 48842-2188

Phone

(517) 111-1111

NPI assigned

Jul 5, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Gary Stolicker, O.D.

Title

Owner

Phone

(517) 899-1658

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Spartan Eyecare Doing business as

Locations

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

{
    "created_epoch": "1499212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499212800000",
    "number": "1174044648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4573 WILLOUGHBY RD STE D",
            "city": "HOLT",
            "state": "MI",
            "postal_code": "488422188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4573 WILLOUGHBY RD STE D",
            "city": "HOLT",
            "state": "MI",
            "postal_code": "488422188",
            "telephone_number": "517-111-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARTAN EYECARE, P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-05",
        "last_updated": "2017-07-05",
        "status": "A",
        "authorized_official_last_name": "STOLICKER",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "517-899-1658",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811195357",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spartan Eyecare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spartan Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.