Kevin Benjamin Vandenbosch, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004710 Issued in MI

Practice address

1116 W Ganson St
Jackson, MI 49202-4240

Phone

(877) 852-8463

Fax

(517) 782-5166

NPI assigned

Jun 14, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Optometry

Education

Indiana University - School of Optometry, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mid Michigan Eye Care Center PCGroup PAC ID 4486566098, 31 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mid Michigan Eye Care Center, PC

  • Ophthalmology Physician
  • Jackson, MI
  • NPI 1649275041

  Optometrist

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1339632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339632000000",
    "number": "1215299367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4615 BREMER ST SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182239",
            "telephone_number": "616-240-5632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 W GANSON ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492024240",
            "telephone_number": "877-852-8463",
            "fax_number": "517-782-5166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDENBOSCH",
        "first_name": "KEVIN",
        "middle_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-14",
        "last_updated": "2012-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Van Tassell, CRNA
• Madelyn Vanarsdalen
• Morgan Nees Vanbaalen, MD
• Colleen Mae Vancampen, LLPC
• Sean Michael Vance, MD
• Zachary Vander Vlucht
• Kelly Vandergiessen, MA CCC-SLP
• Aynsley Victoria Vanderkarr, PA-C
• Ruth Ann Vanderpool-Combs, LLPC
• Beth E Vanderwalker, LMSW

• Optometrist in Jackson, MI
• Providers in Jackson, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.