Sophia Rose Capo, OD

Primary specialty

Pediatric OptometristTaxonomy code 152WP0200X

License

4901005569 Issued in MI

Practice address

1124 S State St
Big Rapids, MI 49307-2256

Phone

(231) 591-3700

NPI assigned

Aug 27, 2021

Last updated

Aug 27, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630022400000",
    "number": "1366119141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 MORRISON ST APT 8",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493072223",
            "telephone_number": "905-851-0675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 S STATE ST",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493072256",
            "telephone_number": "231-591-3700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Cherry St SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495034526",
            "country_code": "US",
            "telephone_number": "616-965-8200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAPO",
        "first_name": "SOPHIA",
        "middle_name": "ROSE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-27",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "MI",
            "license": "4901005569",
            "primary": true
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "MI",
            "license": "4901005569",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Optometrist in Big Rapids, MI
• Providers in Big Rapids, MI by specialty
• Pediatric Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; 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.