Active NPI
Jana Bazzoun, OD
- Optometrist
- Wyandotte, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901005718
- 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, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
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
| License | State | Type | Specialty |
|---|---|---|---|
| 4901005718 | MI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Myeyedr Optometry of Michigan, LLC | Optometrist | Current | Accepting new patients |
| Myeyedr Optometry of Michigan, LLC | Optometrist | Current | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.