Active NPI
Richard J Abbott, O.D.
- Optometrist
- Traverse City, MI
National Provider Identifier
1295721520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901002395
- Practice address
- 929 Business Park Dr
Traverse City, MI 49686-8683 - Phone
- (231) 947-6246
- Fax
- (231) 947-8864
- NPI assigned
- Sep 22, 2005
- Last updated
- Jul 15, 2009
- Sex
- Male
- 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 | 4901002395 | MI | Primary |
Addresses
Primary practice location
929 Business Park Dr
Traverse City, MI 49686-8683
Mailing address
929 Business Park Dr
Traverse City, MI 49686-8683
Phone (231) 947-6246
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3248321 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901002395 | MI | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247616000000",
"number": "1295721520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "929 BUSINESS PARK DR",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496868683",
"telephone_number": "231-947-6246",
"fax_number": "231-947-8864"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "929 BUSINESS PARK DR",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496868683",
"telephone_number": "231-947-6246",
"fax_number": "231-947-8864"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ABBOTT",
"first_name": "RICHARD",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-22",
"last_updated": "2009-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901002395",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3248321",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.