Active NPI
Dirk Schrotenboer, OD
- Optometrist
- Holland, MI
National Provider Identifier
1205807955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 521576
- Practice address
- 11971 James St
Holland, MI 49424-9610 - Phone
- (616) 395-0606
- Fax
- (616) 395-0070
- NPI assigned
- Jan 31, 2006
- 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 | 521576 | MI | Primary |
Addresses
Primary practice location
11971 James St
Holland, MI 49424-9610
Mailing address
11971 James St
Holland, MI 49424-9610
Phone (616) 395-0606
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2940256 | Medicaid | MI | |
| 900G065210 | Other | MI | BLUECROSS BLUESHIELD 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 |
|---|---|---|---|
| 521576 | MI | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277251200000",
"number": "1205807955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11971 JAMES ST",
"city": "HOLLAND",
"state": "MI",
"postal_code": "494249610",
"telephone_number": "616-395-0606",
"fax_number": "616-395-0070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11971 JAMES ST",
"city": "HOLLAND",
"state": "MI",
"postal_code": "494249610",
"telephone_number": "616-395-0606",
"fax_number": "616-395-0070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHROTENBOER",
"first_name": "DIRK",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-31",
"last_updated": "2010-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "521576",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2940256",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUESHIELD ID",
"identifier": "900G065210",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Holland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.