Mid Michigan Family Eye Care PLLC
Organization Active NPI Optometrist · Beaverton, MI
NPI 1356698534 · NPPES record last updated Jun 28, 2013
Key facts
- NPI
- 1356698534
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 4901004640 (MI)
- Legal business name
- MID MICHIGAN FAMILY EYE CARE PLLC
- Practice address
- 334 N Ross St
Beaverton, MI 48612-8165 - Phone
- (989) 435-2020
- Fax
- (989) 435-2554
- NPI assigned
- Aug 7, 2012
- Organization subpart
- No
Authorized official
- Name
- Dr. Brian Michael Hales, O.D.
- Title
- Optometrist
- Phone
- (989) 435-2020
Other NPIs on the same Medicare enrollment 1
Practitioners 3
-
Brian M Hales, O.D.
-
Chad J Jackson, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121205000023 | MI | Part B Supplier - Clinic/Group Practice | 5991957557 |
Receives reassigned benefits from 1 practitioner 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Clare, MI |
National Provider Directory
Locations
1520 N McEwan St
Ste B
Clare, MI 48617
Phone (989) 386-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 4901004640 | MI | Yes |
Addresses
Primary practice location
334 N Ross St
Beaverton, MI 48612-8165
Mailing address
PO Box 505
Beaverton, MI 48612-0505
Phone (989) 435-2020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356698534 | Medicaid | MI | |
| 0A80041 | Other | MI | BLUECROSS BLUESHIED |
Other names
- Mid Michigan Eye
NPI Registry JSON
{
"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": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1356698534",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUESHIED",
"identifier": "0A80041",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Mid Michigan Eye",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Beaverton, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 28, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.