Keith R Moulds OD PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004021 Issued in MI

Legal business name

KEITH R MOULDS OD PC

Doing business as

Alphine Family Eyecare

Practice address

4643 Alpine Ave NW
Suite a
Comstock Park, MI 49321-8179

Phone

(616) 784-8700

Fax

(616) 784-8708

NPI assigned

Nov 23, 2005

Last updated

May 30, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Keith R Moulds, ODNPI 1487645065

Title

President

Phone

(616) 784-8700

Specialties & licenses 1

Addresses

Other names 1

• Alphine Family Eyecare Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

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.

• Keith Ronald Moulds, OD

  • Optometrist
  • Comstock Park, MI
  • NPI 1487645065
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338336000000",
    "number": "1275516155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4643 ALPINE AVE NW",
            "address_2": "SUITE A",
            "city": "COMSTOCK PARK",
            "state": "MI",
            "postal_code": "493218179",
            "telephone_number": "616-784-8700",
            "fax_number": "616-784-8708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4643 ALPINE AVE NW",
            "address_2": "SUITE A",
            "city": "COMSTOCK PARK",
            "state": "MI",
            "postal_code": "493218179",
            "telephone_number": "616-784-8700",
            "fax_number": "616-784-8708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH R MOULDS OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-23",
        "last_updated": "2012-05-30",
        "status": "A",
        "authorized_official_last_name": "MOULDS",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-784-8700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alphine Family Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Comstock Park, MI
• Providers in Comstock Park, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2012; 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.

Verify at the official NPI Registry.