Organization Active NPI

Riverside Eye Center PC

  • Ophthalmology Physician
  • East China, MI
National Provider Identifier
1174748081
Registry record updated Jul 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
RIVERSIDE EYE CENTER PC
Practice address
4050 River Rd
East China, MI 48054-2908
Phone
(810) 329-9045
Fax
(810) 329-8732
NPI assigned
Apr 16, 2007
Last updated
Jul 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2025

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

Authorized official

Name
Kevin Hanton
Title
Manager
Phone
(810) 385-7200

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 1146090001 MI
Optometrist 152W00000X
Ophthalmology Physician 207W00000X MI Primary

Addresses

Primary practice location

4050 River Rd
East China, MI 48054-2908

Mailing address

4050 River Rd
East China, MI 48054-2908
Phone (810) 329-9045

Other practice location 1

17900 23 Mile Rd Ste 100
Macomb, MI 48044-1161
Phone (586) 416-1544

Other practice location 2

4656 24th Ave
Fort Gratiot, MI 48059-3402
Phone (810) 385-3600

Other identifiers 2

IdentifierTypeStateIssuer
180G410170OtherMIBCBS PIN
0741045OtherMIBCBS INDIVIDUAL PIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050620000108 MI Part B Supplier - Clinic/Group Practice 6204870322 Receives reassigned benefits from 5 practitioners
Practice locations: East China, MI; Fort Gratiot, MI; Macomb, MI
O20100930028051 MI DME Supplier - Physician - Ophthalmology 6204870322 Practice locations: East China, MI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2028407Riverside Eye Center PC4050 River Road, East China, MI 48054Certificate of waiverMar 5, 2028
23D2039582Riverside Eye Center4656 24TH Ave, Fort Gratiot, MI 48059Certificate of waiverApr 11, 2028

National Provider Directory

National Provider Directory

Locations

4050 River Rd
Ste 1
East China, MI 48054
Phone (810) 329-9045

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753401600000",
    "number": "1174748081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4050 RIVER RD",
            "city": "EAST CHINA",
            "state": "MI",
            "postal_code": "480542908",
            "telephone_number": "810-329-9045",
            "fax_number": "810-329-8732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4050 RIVER RD",
            "city": "EAST CHINA",
            "state": "MI",
            "postal_code": "480542908",
            "telephone_number": "810-329-9045",
            "fax_number": "810-329-8732"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17900 23 Mile Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Macomb",
            "state": "MI",
            "postal_code": "480441161",
            "country_code": "US",
            "telephone_number": "586-416-1544",
            "fax_number": "586-416-1545",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4656 24th Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Gratiot",
            "state": "MI",
            "postal_code": "480593402",
            "country_code": "US",
            "telephone_number": "810-385-3600",
            "fax_number": "810-385-0603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RIVERSIDE EYE CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2025-07-25",
        "certification_date": "2025-07-25",
        "status": "A",
        "authorized_official_last_name": "HANTON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "810-385-7200"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "1146090001",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN",
            "identifier": "180G410170",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS INDIVIDUAL PIN",
            "identifier": "0741045",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East China, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.