Individual provider Active NPI

John G Ford, OD

  • Optometrist
  • Grand Rapids, MI
National Provider Identifier
1205812229
Registry record updated Jul 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901003328 Issued in MI
Practice address
4070 Lake Dr SE
Suite 101
Grand Rapids, MI 49546-8294
Phone
(616) 949-8500
Fax
(616) 949-2878
NPI assigned
Dec 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901003328 MI Primary

Addresses

Primary practice location

4070 Lake Dr SE
Suite 101
Grand Rapids, MI 49546-8294

Mailing address

4070 Lake Dr SE
Suite 101
Grand Rapids, MI 49546-8294
Phone (616) 949-8500

Other identifiers 1

IdentifierTypeStateIssuer
3484937MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100925000124 MI Practitioner - Optometry 6002911286 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ferris State College - College of Optometry, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Michigan Eyecare Associates LLCGroup PAC ID 2567567746, 5 clinicians

Practice addresses (Care Compare)

2112 E Paris Ave SE
Grand Rapids, MI 49546-6106
Phone (616) 949-8500

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4901003328MIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
West Michigan Eyecare Associates LLC Optometrist CurrentSince Apr 1, 1998 Accepting new patients

Locations

2112 East Paris Ave SE
Grand Rapids, MI 49546
Phone (616) 949-8500

4070 Lake Dr SE
Ste 101
Grand Rapids, MI 49546
Phone (616) 455-4114

Interoperability endpoints

  • Direct secure messaging: dr.ford@west-michigan-eyecare.direct.kno2fy.com

Organizations & group practices 1

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": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280361600000",
    "number": "1205812229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4070 LAKE DR SE",
            "address_2": "SUITE 101",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468294",
            "telephone_number": "616-949-8500",
            "fax_number": "616-949-2878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4070 LAKE DR SE",
            "address_2": "SUITE 101",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468294",
            "telephone_number": "616-949-8500",
            "fax_number": "616-949-2878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORD",
        "first_name": "JOHN",
        "middle_name": "G",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-21",
        "last_updated": "2010-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3484937",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.