Carrie Dewolfe, O.D.
Individual provider Active NPI Optometrist · Caledonia, MI
NPI 1184283285 · NPPES record last updated Jun 14, 2023
Key facts
- NPI
- 1184283285
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 4901005247 (MI)
- Practice address
- 9028 N Rodgers CT SE Ste K
Caledonia, MI 49316-7786 - Phone
- (168) 916-9245
- Fax
- (616) 891-4321
- NPI assigned
- Jun 12, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
9028 N Rodgers CT SE
Suite K
Caledonia, MI 49316-7786
Phone (616) 891-9245
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210302000315 | MI | Practitioner - Optometry | 2567878424 |
Reassigns benefits to 2 organizations Practice locations: Caledonia, MI |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Richard H Benninger MD PC | Optometrist | Current |
Accepting new patients |
| Dr. Carrie Dewolfe OD PCL | Optometrist | Current |
Accepting new patients |
| Michigan Street Optical | Past |
Accepting new patients |
Locations
9028 N Rodgers Ct SE
Ste K
Caledonia, MI 49316
Phone (616) 891-9245
833 Michigan St NE
Ste 101
Grand Rapids, MI 49503
Phone (616) 459-1844
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901005247 | MI | Yes |
Addresses
Primary practice location
9028 N Rodgers CT SE Ste K
Caledonia, MI 49316-7786
Mailing address
833 Michigan St NE Ste 101
Grand Rapids, MI 49503-2578
Phone (989) 245-8038
Other practice location 1
833 Michigan St NE Ste 101
Grand Rapids, MI 49503-2578
Phone (616) 459-3713
Other names
- Carrie Mitera
Other providers in Caledonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.