NPIMap

Individual provider Active NPI

Nancy Peterson Klein, OD

  • Optometrist
  • Big Rapids, MI
National Provider Identifier
1356358022
Registry record updated Jan 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901002580 Issued in MI
Practice address
1310 Cramer Circle
Pennock 506
Big Rapids, MI 49307-2738
Phone
(231) 591-2222
Fax
(231) 591-3991
NPI assigned
Aug 2, 2006
Last updated
Jan 9, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901002580 MI Primary

Addresses

Primary practice location

1310 Cramer Circle
Pennock 506
Big Rapids, MI 49307-2738

Mailing address

1310 Cramer Circle
Pennock 506
Big Rapids, MI 49307-2738
Phone (231) 591-2222

Other identifiers 2

IdentifierTypeStateIssuer
4401705MedicaidMI
NP002580OtherMIBLUE CROSS

Other names 1

  • Nancy Peterson Uniacke Former name

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
4901002580MIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Ferris State University Past Accepting new patients
Ferris State University Optometrist Past Accepting new patients

Organizations & group practices 2

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": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199836800000",
    "number": "1356358022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 CRAMER CIRCLE",
            "address_2": "PENNOCK 506",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493072738",
            "telephone_number": "231-591-2222",
            "fax_number": "231-591-3991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 CRAMER CIRCLE",
            "address_2": "PENNOCK 506",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493072738",
            "telephone_number": "231-591-2222",
            "fax_number": "231-591-3991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON KLEIN",
        "first_name": "NANCY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-02",
        "last_updated": "2008-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901002580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4401705",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "NP002580",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NANCY",
            "last_name": "UNIACKE",
            "middle_name": "PETERSON",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Big Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2008; 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.