NPIMap

Organization Active NPI

Heritage Optical Center Inc

  • Optometrist
  • Detroit, MI
National Provider Identifier
1285728964
Registry record updated Dec 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4601003146 Issued in MI
Legal business name
HERITAGE OPTICAL CENTER INC
Practice address
19010 Livernois Ave
Detroit, MI 48221-2259
Phone
(313) 863-9581
Fax
(313) 863-7710
NPI assigned
Oct 3, 2006
Last updated
Dec 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2023

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

Authorized official

Name
Mr. George P Barnes Jr.
Title
Owner Ceo
Phone
(313) 863-9585

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 4601003146 MI Primary

Addresses

Primary practice location

19010 Livernois Ave
Detroit, MI 48221-2259

Mailing address

19010 Livernois Ave
Detroit, MI 48221-2259
Phone (313) 863-9581

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071024000612 MI Part B Supplier - Clinic/Group Practice 1052408986 Receives reassigned benefits from 18 practitioners
Practice locations: Detroit, MI

National Provider Directory

National Provider Directory
Tax ID family
Heritage Optical Center Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703030400000",
    "number": "1285728964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19010 LIVERNOIS AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482212259",
            "telephone_number": "313-863-9581",
            "fax_number": "313-863-7710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19010 LIVERNOIS AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482212259",
            "telephone_number": "313-863-9581",
            "fax_number": "313-863-7710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE OPTICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A",
        "authorized_official_last_name": "BARNES",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER CEO",
        "authorized_official_telephone_number": "313-863-9585",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4601003146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; 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.