Active NPI
Robert Michael Hardy, OD
- Optometrist
- Fremont, MI
National Provider Identifier
1174518617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901002366
- Practice address
- 1231 W Main St
Fremont, MI 49412-1484 - Phone
- (231) 924-2700
- Fax
- (231) 924-9255
- NPI assigned
- Sep 12, 2005
- Last updated
- Apr 29, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901002366 | MI | Primary |
Addresses
Primary practice location
1231 W Main St
Fremont, MI 49412-1484
Mailing address
105 W Exchange St
Spring Lake, MI 49456-2024
Phone (616) 846-0620
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 900F111210 | Other | MI | BCBS OF MICHIGAN |
| 204829649 | Other | MI | TAX ID |
| 383628290 | Other | MI | TAX ID |
| 4901002366 | Other | MI | STATE LICENSE |
| 4956685 | Medicaid | MI | |
| 5175725 | Medicaid | MI | |
| 900F210170 | Other | MI | BCBS OF MICHIGAN |
| 4964990 | Medicaid | MI | |
| U37641 | Other | MI | UPIN |
| 202916337 | Other | MI | TAX ID |
| 201249427 | Other | MI | TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901002366 | MI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eye Care One, PLLC | Optometrist | Past | Accepting new patients |
| Kent Vision Centers Inc | Optometrist | Past | Accepting new patients |
| Kent Vision Centers Inc | Optometrist | Past | Accepting new patients |
| Goodwill Optical Inc | Optometrist | Past | Accepting new patients |
| Goodwill Optical Inc | Optometrist | Past | Accepting new patients |
| Smeelink Acquisitions Inc | Optometrist | Past | Accepting new patients |
| Goodwill Optical LLC | Optometrist | Past | Accepting new patients |
| Goodwill Optical, Inc | Optometrist | Past | Accepting new patients |
| Goodwill Optical Inc | Optometrist | Past | Accepting new patients |
| Goodwill Optical Inc | Optometrist | Past | Accepting new patients |
| Smeelink Acquisitions Inc | Optometrist | Past | Accepting new patients |
| Goodwill Optical Inc | Optometrist | Past | Accepting new patients |
| Goodwill Optical Inc | Optometrist | Past | Accepting new patients |
| Smeelink Acquisitions Inc | Optometrist | Past | Accepting new patients |
| Kent Vision Centers Inc | Optometrist | Past | Accepting new patients |
| Goodwill Optical Inc | Optometrist | Past | Accepting new patients |
Organizations & group practices 16
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": "1126483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240963200000",
"number": "1174518617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 W EXCHANGE ST",
"city": "SPRING LAKE",
"state": "MI",
"postal_code": "494562024",
"telephone_number": "616-846-0620",
"fax_number": "616-844-6079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1231 W MAIN ST",
"city": "FREMONT",
"state": "MI",
"postal_code": "494121484",
"telephone_number": "231-924-2700",
"fax_number": "231-924-9255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARDY",
"first_name": "ROBERT",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-12",
"last_updated": "2009-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901002366",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MICHIGAN",
"identifier": "900F111210",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "204829649",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "383628290",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "4901002366",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4956685",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5175725",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MICHIGAN",
"identifier": "900F210170",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4964990",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UPIN",
"identifier": "U37641",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "202916337",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "201249427",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fremont, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.