Promedica Central Physicians LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

PROMEDICA CENTRAL PHYSICIANS LLC

Practice address

1180 N Monroe St
Monroe, MI 48162-3190

Phone

(734) 243-5300

Fax

(734) 243-3236

NPI assigned

Dec 10, 2014

Organization subpart

No

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

Authorized official

Name

Amy L Dywer

Title

Credentialing Supervisor

Phone

(419) 824-7334

Specialties & licenses 2

Addresses

Other names 1

• ProMedica Physicians Eye Care Doing business as

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

{
    "created_epoch": "1418169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418169600000",
    "number": "1417355223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 N MONROE ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481623190",
            "telephone_number": "734-243-5300",
            "fax_number": "734-243-3236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 N MONROE ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481623190",
            "telephone_number": "734-243-5300",
            "fax_number": "734-243-3236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDICA CENTRAL PHYSICIANS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-10",
        "last_updated": "2014-12-10",
        "status": "A",
        "authorized_official_last_name": "DYWER",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "419-824-7334"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProMedica Physicians Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Puente
• Pulmonary N Sleep Specialists PC
• Pure Psychiatry of Michigan PLLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2014; 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.