Individual provider Active NPI

Bailey Elise Pearson, OD

  • Optometrist
  • Gaylord, MI
National Provider Identifier
1275026767
Registry record updated Jun 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901005116 Issued in MI
Practice address
713 S Wisconsin Ave
Gaylord, MI 49735
Phone
(989) 705-1255
NPI assigned
Jun 11, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 18, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901005116 MI Primary

Addresses

Primary practice location

713 S Wisconsin Ave
Gaylord, MI 49735

Mailing address

3830 Van Tyle Rd
Gaylord, MI 49735-9209
Phone (989) 619-6473

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181024001828 MI Practitioner - Optometry 8921351701 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ferris State College - College of Optometry, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SVS Vision IncGroup PAC ID 9931257110, 41 clinicians

Practice addresses (Care Compare)

455 E Grand River Ave
Brighton, MI 48116-1551
Phone (810) 227-2376

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4901005116MIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
SVS Vision Inc Optometrist CurrentSince Dec 13, 2018 Accepting new patients
SVS Vision Inc Optometrist CurrentSince Dec 13, 2018 Accepting new patients

Locations

455 E Grand River Ave
Brighton, MI 48116
Phone (810) 227-2376

1407 W Main St
Gaylord, MI 49735
Phone (989) 217-3075

118 Cass Ave
Mount Clemens, MI 48043
Phone (586) 464-1479

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1528675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529280000000",
    "number": "1275026767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3830 VAN TYLE RD",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497359209",
            "telephone_number": "989-619-6473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "713 S WISCONSIN AVE",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "49735",
            "telephone_number": "989-705-1255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARSON",
        "first_name": "BAILEY",
        "middle_name": "ELISE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-11",
        "last_updated": "2018-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901005116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaylord, MI

Sources for this page

Verify at the official NPI Registry.