Son OD PLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

SON OD PLC

Practice address

201 N Riverside Ave
Saint Clair, MI 48079-5491

Phone

(800) 743-0396

NPI assigned

Apr 22, 2022

Organization subpart

No

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

Authorized official

Name

Jerrolynn Justusson

Title

President

Phone

(800) 743-0396

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1650585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650585600000",
    "number": "1255075693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 N RIVERSIDE AVE",
            "city": "SAINT CLAIR",
            "state": "MI",
            "postal_code": "480795491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N RIVERSIDE AVE",
            "city": "SAINT CLAIR",
            "state": "MI",
            "postal_code": "480795491",
            "telephone_number": "800-743-0396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SON OD PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-22",
        "last_updated": "2022-04-22",
        "certification_date": "2022-04-22",
        "status": "A",
        "authorized_official_last_name": "JUSTUSSON",
        "authorized_official_first_name": "JERROLYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "800-743-0396"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Saint Clair, MI
• Providers in Saint Clair, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.