Individual provider Active NPI

Brittany Ann Boland, O.D.

  • Optometrist
  • Northville, MI
National Provider Identifier
1285912089
Registry record updated Feb 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901004664 Issued in MI
Practice address
39901 Traditions Dr
Suite 230
Northville, MI 48168-9493
Phone
(248) 305-4400
NPI assigned
Jul 27, 2011
Last updated
Feb 10, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901004664 MI Primary

Addresses

Primary practice location

39901 Traditions Dr
Suite 230
Northville, MI 48168-9493

Mailing address

3621 S State St
Ann Arbor, MI 48108-1633
Phone (734) 647-5299

Other practice location 1

4646 John R St
Detroit, MI 48201
Phone (313) 576-1000

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
I20121102000250 MI Practitioner - Optometry 1759532542 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1000 Wall St
Ann Arbor, MI 48105-1912
Phone (734) 764-4190

39901 Traditions Dr
Northville, MI 48168-9493
Phone (734) 764-4190

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4901004664MIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan Optometrist CurrentSince Oct 23, 2018 Accepting new patients
Regents of the University of Michigan CurrentSince Oct 23, 2018 Accepting new patients
Regents of the University of Michigan Past Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

1000 Wall St
Ann Arbor, MI 48105
Phone (734) 763-1415

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

3621 S State St
Ann Arbor, MI 48108
Phone (734) 647-5229

39901 Traditions Dr
Northville, MI 48168
Phone (248) 305-4400

39901 Traditions Dr
Ste 230
Northville, MI 48168
Phone (248) 305-4400

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1311724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1285912089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081633",
            "telephone_number": "734-647-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39901 TRADITIONS DR",
            "address_2": "SUITE 230",
            "city": "NORTHVILLE",
            "state": "MI",
            "postal_code": "481689493",
            "telephone_number": "248-305-4400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4646 John R St",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "48201",
            "country_code": "US",
            "telephone_number": "313-576-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLAND",
        "first_name": "BRITTANY",
        "middle_name": "ANN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-27",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northville, MI

Sources for this page

Verify at the official NPI Registry.