Mac Optical

Primary specialty

OptometristTaxonomy code 152W00000X

License

MH003723 Issued in MI

Legal business name

MAC OPTICAL

Practice address

1425 N Leroy St
Fenton, MI 48430-2763

Phone

(810) 629-2041

Fax

(810) 629-9366

NPI assigned

Mar 14, 2007

Organization subpart

No

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

Authorized official

Name

Michael G Hendricks

Title

Owner

Phone

(810) 629-2041

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Diamond Optical Care Doing business as

Locations

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297209600000",
    "number": "1295868602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 N. LEROY ST",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "48430",
            "telephone_number": "810-664-5929",
            "fax_number": "810-664-4915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 N LEROY ST",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484302763",
            "telephone_number": "810-629-2041",
            "fax_number": "810-629-9366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAC OPTICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2011-02-09",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-629-2041"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "MH003723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP",
            "identifier": "0N11050",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "900D41012",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0D41012",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3442900",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "943442900",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diamond Optical Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hayley Lubinski, LLMSW
• Marta Elizabeth Lundquist-Shaw
• Kathryn Luther, DPT
• Suzanne Lynch
• Mac Optical
• Tammy Mackenzie
• Kaelin Magrath, PA-C
• David Alan Mahan, BCHIS
• Hillary Margaret May Maier, LPC
• Jennifer E Malone

• Optometrist in Fenton, MI
• Providers in Fenton, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.