Active NPI
Dale W Muth OD PLLC
- Optometrist
- Newberry, MI
National Provider Identifier
1255463162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901003944
- Legal business name
- DALE W MUTH OD PLLC
- Practice address
- 504 W Harrie St
Newberry, MI 49868-1200 - Phone
- (902) 293-9276
- Fax
- (906) 293-9100
- NPI assigned
- Mar 9, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Dale W Muth, OD
- Title
- Optometrist
- Phone
- (906) 293-9276
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901003944 | MI | Primary |
Addresses
Primary practice location
504 W Harrie St
Newberry, MI 49868-1200
Mailing address
504 W Harrie St
Newberry, MI 49868-1200
Phone (902) 293-9276
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 900D800030 | Other | MI | BCBS OF MICHIGAN |
| 944255821 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081115000177 | MI | Part B Supplier - Clinic/Group Practice | 8325108780 |
Receives reassigned benefits from 4 practitioners Practice locations: Munising, MI; Newberry, MI; Saint Ignace, MI |
National Provider Directory
National Provider DirectoryLocations
216 Elm Ave
Munising, MI 49862
Phone (906) 291-2015
504 W Harrie St
Newberry, MI 49868
Phone (906) 291-2015
248 Ferry Ln
Saint Ignace, MI 49781
Phone (906) 643-8111
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173398400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1433808000000",
"number": "1255463162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "504 W HARRIE ST",
"city": "NEWBERRY",
"state": "MI",
"postal_code": "498681200",
"telephone_number": "902-293-9276",
"fax_number": "906-293-9100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "504 W HARRIE ST",
"city": "NEWBERRY",
"state": "MI",
"postal_code": "498681200",
"telephone_number": "902-293-9276",
"fax_number": "906-293-9100"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DALE W MUTH OD PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-09",
"last_updated": "2015-06-09",
"status": "A",
"authorized_official_last_name": "MUTH",
"authorized_official_first_name": "DALE",
"authorized_official_middle_name": "W",
"authorized_official_title_or_position": "OPTOMETRIST",
"authorized_official_telephone_number": "906-293-9276",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "MI",
"license": "4901003944",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MICHIGAN",
"identifier": "900D800030",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "944255821",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newberry, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2015; 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.