Stadium Opticians, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901003645 Issued in MI

Legal business name

STADIUM OPTICIANS, INC.

Practice address

2333 W Stadium Blvd
Ann Arbor, MI 48103-3844

Phone

(734) 663-0870

Fax

(734) 761-5242

NPI assigned

Jan 23, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Charles R. Meldrum, OPTICIAN

Title

Pres.

Phone

(734) 663-0870

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Stadium Opticians, Inc.

  • Optician
  • Ann Arbor, MI
  • NPI 1851443766

  6103815204

  Same PAC ID

Tax ID family

Stadium Opticians Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Stadium Opticians, Inc.

  • Optometrist
  • Ann Arbor, MI
  • NPI 1467584169
  NPD tax ID
• Stadium Opticians, Inc.

  • Optician
  • Ann Arbor, MI
  • NPI 1851443766
  NPD tax ID

Locations

Practitioners 3

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

• Cole William Jordan, OD

  • Optometrist
  • Detroit, MI
  • NPI 1851082309
  Medicare reassignment Care Compare group NPD
• Brian Eric Pierce, OD

  • Optometrist
  • Canton, MI
  • NPI 1699830646
  Medicare reassignment Care Compare group NPD
• Olivia Michelle Marineau, OD

  • Optometrist
  • Canton, MI
  • NPI 1275159246
  Medicare reassignment NPD

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245384544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2333 W STADIUM BLVD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481033844",
            "telephone_number": "734-663-0870",
            "fax_number": "734-761-5242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2333 W STADIUM BLVD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481033844",
            "telephone_number": "734-663-0870",
            "fax_number": "734-761-5242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STADIUM OPTICIANS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MELDRUM",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRES.",
        "authorized_official_telephone_number": "734-663-0870",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OPTICIAN"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MI VISION",
            "identifier": "900H16511",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tara Stacey, OD
• William Charles Stacey, MD
• Casey J Stach, M.A.
• Michael Stack, EP
• John Joseph Stacy, MLTDSW, CAC-1
• Stadium Opticians, Inc.
• Stadium Opticians, Inc.
• Leonard Louis Stadtmiller, R.PH.
• Emma Stafne
• Alisa W. Stager, PA

• Optometrist in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.