Individual provider Active NPI

Olivia Michelle Marineau, OD

  • Optometrist
  • Canton, MI
National Provider Identifier
1275159246
Registry record updated Jun 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901005428 Issued in MI
Practice address
325 N Lilley Rd
Canton, MI 48187-3908
Phone
(734) 981-2700
NPI assigned
Jun 24, 2020
Last updated
Jun 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901005428 MI Primary

Addresses

Primary practice location

325 N Lilley Rd
Canton, MI 48187-3908

Mailing address

PO Box 280
Douglas, MI 49406-0280
Phone (812) 251-9268

Other practice location 1

2333 W Stadium Blvd
Ann Arbor, MI 48103-3844
Phone (734) 663-0870

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
I20210707000528 MI Practitioner - Optometry 1850793365 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

114 Blue Star Hwy
Douglas, MI 49406-5139
Phone (269) 857-2020

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4901005428MIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Richard C Annis OD PC Optometrist CurrentSince Jun 15, 2024 Accepting new patients
Stadium Opticians, Inc. Optometrist CurrentSince Jun 14, 2023 Accepting new patients
Marineau Eye Care, PLC Optometrist CurrentSince Jun 15, 2024 Accepting new patients

Locations

2333 W Stadium Blvd
Ann Arbor, MI 48103

2335 W Stadium Blvd
Ann Arbor, MI 48103

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1592956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1275159246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 280",
            "city": "DOUGLAS",
            "state": "MI",
            "postal_code": "494060280",
            "telephone_number": "812-251-9268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 N LILLEY RD",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481873908",
            "telephone_number": "734-981-2700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2333 W Stadium Blvd",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481033844",
            "country_code": "US",
            "telephone_number": "734-663-0870",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARINEAU",
        "first_name": "OLIVIA",
        "middle_name": "MICHELLE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-24",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901005428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MI

Sources for this page

Verify at the official NPI Registry.