Kevin Michael Fountain, O.D.
Individual provider Active NPI Optometrist · Milan, MI
NPI 1376563775 · NPPES record last updated Aug 3, 2023
Key facts
- NPI
- 1376563775
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 4901004264 (MI)
- Practice address
- 7 E Main St
Milan, MI 48160-1248 - Phone
- (734) 439-2020
- Fax
- (734) 439-2047
- NPI assigned
- Jul 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Ferris State College - College of Optometry, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Fountain Optometry, P.C.
Practice addresses (Care Compare)
31 E Main St
Milan, MI 48160-1475
Phone (734) 439-2020
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061120000472 | MI | Practitioner - Optometry | 1052319399 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901004264 | MI | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901004264 | MI | Yes |
Addresses
Primary practice location
7 E Main St
Milan, MI 48160-1248
Mailing address
7 E Main St
Milan, MI 48160-1248
Phone (734) 439-2020
Other providers in Milan, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2023. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.