NPIMap

Organization Active NPI

Grand Traverse Ophthalmology Clinic PC

  • Ophthalmology Physician
  • Traverse City, MI
National Provider Identifier
1265426514
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
GRAND TRAVERSE OPHTHALMOLOGY CLINIC PC
Practice address
929 Business Park Dr
Traverse City, MI 49686-8683
Phone
(231) 947-6246
Fax
(231) 947-8864
NPI assigned
Sep 1, 2005
Last updated
Apr 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Authorized official

Name
Mrs. Deanne L Musser
Title
Billing Manager
Phone
(231) 932-4336

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X
Ophthalmology Physician 207W00000X Primary

Addresses

Primary practice location

929 Business Park Dr
Traverse City, MI 49686-8683

Mailing address

929 Business Park Dr
Traverse City, MI 49686-8683
Phone (231) 947-6246

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040724000399 MI Part B Supplier - Clinic/Group Practice 4981503521 Receives reassigned benefits from 13 practitioners
Practice locations: Traverse City, MI; Petoskey, MI; Sault Sainte Marie, MI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2078847Grand Traverse Ophthalmology Clinic P C929 Business Park Drive, Traverse City, MI 49686Certificate of waiverJun 4, 2028

National Provider Directory

National Provider Directory

Locations

215 S High St
Northport, MI 49670
Phone (231) 271-5161

929 Business Park Dr
Traverse City, MI 49686
Phone (231) 932-4336

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1125532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1265426514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 BUSINESS PARK DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496868683",
            "telephone_number": "231-947-6246",
            "fax_number": "231-947-8864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 BUSINESS PARK DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496868683",
            "telephone_number": "231-947-6246",
            "fax_number": "231-947-8864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND TRAVERSE OPHTHALMOLOGY CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-01",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A",
        "authorized_official_last_name": "MUSSER",
        "authorized_official_first_name": "DEANNE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "231-932-4336",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.