NPIMap

Organization Active NPI

Goodwill Optical Inc

  • Optometrist
  • Flint, MI
National Provider Identifier
1447542485
Registry record updated May 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901003723 Issued in MI
Legal business name
GOODWILL OPTICAL INC
Practice address
4340 Miller Rd
Suite a
Flint, MI 48507-1297
Phone
(810) 230-0045
Fax
(810) 230-0045
NPI assigned
May 10, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2011

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

Authorized official

Name
Timothy D Westra
Title
President
Phone
(616) 846-0620

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 4901003723 MI Primary

Addresses

Primary practice location

4340 Miller Rd
Suite a
Flint, MI 48507-1297

Mailing address

105 W Exchange St
Spring Lake, MI 49456-2024
Phone (616) 846-0620

Other identifiers 1

IdentifierTypeStateIssuer
1447319710MedicaidMI

Other names 1

  • GOODWILL OPTICAL Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Goodwill Optical15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

4340 Miller Rd
Ste A
Flint, MI 48507
Phone (810) 230-0045

NPI Registry JSON

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

{
    "created_epoch": "1304985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304985600000",
    "number": "1447542485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 W EXCHANGE ST",
            "city": "SPRING LAKE",
            "state": "MI",
            "postal_code": "494562024",
            "telephone_number": "616-846-0620",
            "fax_number": "616-844-6079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4340 MILLER RD",
            "address_2": "SUITE A",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485071297",
            "telephone_number": "810-230-0045",
            "fax_number": "810-230-0045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOODWILL OPTICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-10",
        "last_updated": "2011-05-10",
        "status": "A",
        "authorized_official_last_name": "WESTRA",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-846-0620"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447319710",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GOODWILL OPTICAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flint, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2011; 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.