Individual provider Active NPI

Jana Bazzoun, OD

  • Optometrist
  • Wyandotte, MI
National Provider Identifier
1295428613
Registry record updated Jun 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901005718 Issued in MI
Practice address
3101 Biddle Ave
Wyandotte, MI 48192-5915
Phone
(734) 282-5030
Fax
(734) 282-5189
NPI assigned
May 31, 2023
Last updated
Jun 19, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 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 4901005718 MI Primary

Addresses

Primary practice location

3101 Biddle Ave
Wyandotte, MI 48192-5915

Mailing address

8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899

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
I20230714002322 MI Practitioner - Optometry 7911367578 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2023
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

22750 Allen Rd
Woodhaven, MI 48183-2246
Phone (734) 676-4300

3101 Biddle Ave
Wyandotte, MI 48192-5915
Phone (734) 282-5189

48873 Hayes Rd
Shelby Township, MI 48315-4405
Phone (586) 247-2121

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4901005718MIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Michigan, LLC Optometrist CurrentSince Jul 12, 2023 Accepting new patients
Myeyedr Optometry of Michigan, LLC Optometrist CurrentSince Jul 12, 2023 Accepting new patients
Myeyedr Optometry of Michigan, LLC Optometrist Current Accepting new patients

Locations

3275 Washtenaw Ave
Ann Arbor, MI 48104
Phone (269) 342-0003

1675 N Canton Center Rd
Canton, MI 48187
Phone (734) 844-0400

1617 N West Ave
Jackson, MI 49202
Phone (517) 780-3828

800 S Brown St
Jackson, MI 49203
Phone (517) 787-8890

29474 7 Mile Rd
Livonia, MI 48152
Phone (248) 615-2815

48873 Hayes Rd
Shelby Township, MI 48315
Phone (586) 247-2121

22750 Allen Rd
Woodhaven, MI 48183
Phone (734) 676-4300

3101 Biddle Ave
Wyandotte, MI 48192
Phone (734) 282-5030

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 3

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": "1685491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718755200000",
    "number": "1295428613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 WESTWOOD CENTER DR FL 9",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221822442",
            "telephone_number": "703-847-8899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 BIDDLE AVE",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481925915",
            "telephone_number": "734-282-5030",
            "fax_number": "734-282-5189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAZZOUN",
        "first_name": "JANA",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-31",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901005718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyandotte, MI

Sources for this page

Verify at the official NPI Registry.