Gladstone Eye Care PC
Organization Active NPI Optometrist · Gladstone, MI
NPI 1245515345 · NPPES record last updated Oct 20, 2011
Key facts
- NPI
- 1245515345
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 4901004220 (MI)
- Legal business name
- GLADSTONE EYE CARE PC
- Practice address
- 20 S 10TH St
Gladstone, MI 49837-1526 - Phone
- (906) 420-8322
- Fax
- (906) 420-8322
- NPI assigned
- Oct 20, 2011
- Organization subpart
- No
Authorized official
- Name
- Dr. Jessica Marie Cameron, O.D.
- Title
- President
- Phone
- (906) 420-8322
Practitioners 2
-
Jessica M Cameron, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111109000198 | MI | Part B Supplier - Clinic/Group Practice | 4688847502 |
Receives reassigned benefits from 2 practitioners Practice locations: Gladstone, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 4901004220 | MI | Yes |
Addresses
Primary practice location
20 S 10TH St
Gladstone, MI 49837-1526
Mailing address
20 S 10TH St
Gladstone, MI 49837-1526
Phone (906) 420-8322
Other providers in Gladstone, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2011. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.