Mid Michigan Family Eye Care PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004640 Issued in MI

Legal business name

MID MICHIGAN FAMILY EYE CARE PLLC

Doing business as

Mid Michigan Eye

Practice address

334 N Ross St
Beaverton, MI 48612-8165

Phone

(989) 435-2020

Fax

(989) 435-2554

NPI assigned

Aug 7, 2012

Last updated

Jun 28, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Brian Michael Hales, O.D.NPI 1154619286

Title

Optometrist

Phone

(989) 435-2020

Specialties & licenses 1

Addresses

Other names 1

• Mid Michigan Eye Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Mid Michigan Family Eye Care PLLC

  dba Mid Michigan Eye

  • Optometrist
  • Clare, MI
  • NPI 1902152762

  O20121205000023

  Same enrollment

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brian M Hales, O.D.

  • Optometrist
  • Clare, MI
  • NPI 1154619286
  NPD Authorized official
• Chad J Jackson, OD

  • Optometrist
  • Rockford, MI
  • NPI 1780772533
  NPD (past)
• Dale J Moser

  • Optometrist
  • Clare, MI
  • NPI 1972691202
  NPD (past)

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

{
    "created_epoch": "1344297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372377600000",
    "number": "1356698534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 505",
            "city": "BEAVERTON",
            "state": "MI",
            "postal_code": "486120505",
            "telephone_number": "989-435-2020",
            "fax_number": "989-435-2554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "334 N ROSS ST",
            "city": "BEAVERTON",
            "state": "MI",
            "postal_code": "486128165",
            "telephone_number": "989-435-2020",
            "fax_number": "989-435-2554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID MICHIGAN FAMILY EYE CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-07",
        "last_updated": "2013-06-28",
        "status": "A",
        "authorized_official_last_name": "HALES",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "989-435-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid Michigan Eye",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Susan M Knoerr, DNP,FNP
• Arlene Lynn Krager, MA, LPC, CAC-II, SAP
• Rosemary McCallum-Herbert, LMSW, CAAC
• Jenna M McCummings, AGPCNP-BC
• Adrienne McNew
• Midmichigan Health Services (Midmichigan Medical Offices-Beaverton)
• Midmichigan Health Services (Beaverton School Wellness Center)
• Midmichigan Infusion Care
• Joy L Monroe, LPC
• Mymichigan Medical Center Clare

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.