Oculoplastic Associates of West Michigan, PLC

Primary specialty

Ophthalmic Plastic and Reconstructive Surgery PhysicianTaxonomy code 207WX0200X

License

4301092933 Issued in MI

Legal business name

OCULOPLASTIC ASSOCIATES OF WEST MICHIGAN, PLC

Practice address

4070 Lake Dr SE
Suite 205
Grand Rapids, MI 49546-8294

Phone

(616) 888-2948

Fax

(616) 888-2949

NPI assigned

Jun 28, 2016

Organization subpart

No

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

Authorized official

Name

Tiffany L Kent, MD, PHDNPI 1164686812

Title

Owner, Physician

Phone

(616) 888-2948

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tiffany Lauren Kent, MD, PHD

  • Ophthalmic Plastic and Reconstructive Surgery Physician
  • Grand Rapids, MI
  • NPI 1164686812
  Medicare reassignment Care Compare group NPD Authorized official
• Michael Hugh Boyle, M.D.

  • Ophthalmic Plastic and Reconstructive Surgery Physician
  • Grand Rapids, MI
  • NPI 1336101740
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1467072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475625600000",
    "number": "1174974356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4070 LAKE DR SE",
            "address_2": "SUITE 205",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468294",
            "telephone_number": "616-888-2948",
            "fax_number": "616-888-2949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4070 LAKE DR SE",
            "address_2": "SUITE 205",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468294",
            "telephone_number": "616-888-2948",
            "fax_number": "616-888-2949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCULOPLASTIC ASSOCIATES OF WEST MICHIGAN, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-28",
        "last_updated": "2016-10-05",
        "status": "A",
        "authorized_official_last_name": "KENT",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER, PHYSICIAN",
        "authorized_official_telephone_number": "616-888-2948",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "207WX0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": "MI",
            "license": "4301092933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1164686812",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Conrad Ocomen
• Brian Matthew Oconnell, PT, OCS, CERT MDT
• Ashley Nicole Oconnor, RRT
• John R Oconnor, PT
• Richard Phillip Oconnor Jr., MD
• Coby K Odate
• Dana Odell
• Emily Patricia Odenbach, PT, DPT
• Afokoghene Hezekiah Odhu, NP
• Ezra Odioko

• Ophthalmic Plastic and Reconstructive Surgery Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Ophthalmic Plastic and Reconstructive Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.