Michael Joseph Sistick, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901003598 Issued in MI

Practice address

4288 Baldwin Rd
Auburn Hills, MI 48326-1268

Phone

(248) 253-0900

Fax

(248) 332-4952

NPI assigned

Apr 10, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fraser Optical Clinic, Inc.

  • Optometrist
  • Fraser, MI
  • NPI 1447326244
  NPD (past)
• Luxottica of America Inc

  • Eyewear Supplier
  • Kansas City, MO
  • NPI 1497412522
  NPD (past)

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268352000000",
    "number": "1316060569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4288 BALDWIN RD",
            "city": "AUBURN HILLS",
            "state": "MI",
            "postal_code": "483261268",
            "telephone_number": "248-253-0900",
            "fax_number": "248-332-4952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4288 BALDWIN RD",
            "city": "AUBURN HILLS",
            "state": "MI",
            "postal_code": "483261268",
            "telephone_number": "248-253-0900",
            "fax_number": "248-332-4952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISTICK",
        "first_name": "MICHAEL",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-10",
        "last_updated": "2010-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003598",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYE MED",
            "identifier": "110955",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "900E06513",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3404800",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew R Shooltz, OTRL
• Paul Siatczynski, M.D.
• Maria Lisa Sica
• Robert Thomas Sims Jr., RN
• Deborah Lila-Duben Singer, M.A. L.L.P.
• Ryan Michael Siwiec, D.O.
• Carli N Skaggs, LLMSW
• John Edward Skwirsk, LBSW
• Sleep Dentistry of Detroit
• Sleep Medicine of Detroit

• Optometrist in Auburn Hills, MI
• Providers in Auburn Hills, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.