Ada Vision Center PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901002630 Issued in MI

Legal business name

ADA VISION CENTER PLLC

Practice address

596 Ada Dr SE
Ada, MI 49301-8465

Phone

(616) 676-1283

Fax

(616) 676-9133

NPI assigned

Jul 17, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Thomas P. Reyburn, O.D.

Title

Owner Since 1977

Phone

(616) 676-1283

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stacy L Davis, O.D.

  • Optometrist
  • Ada, MI
  • NPI 1891880548
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689292800000",
    "number": "1467479212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "596 ADA DR SE",
            "city": "ADA",
            "state": "MI",
            "postal_code": "493018465",
            "telephone_number": "616-676-1283",
            "fax_number": "616-676-9133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "596 ADA DR SE",
            "city": "ADA",
            "state": "MI",
            "postal_code": "493018465",
            "telephone_number": "616-676-1283",
            "fax_number": "616-676-9133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADA VISION CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A",
        "authorized_official_last_name": "REYBURN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "OWNER SINCE 1977",
        "authorized_official_telephone_number": "616-676-1283",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901002630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4140369",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maha Mortada Abdallah, MS, RDN
• Ada Village Pharmacy
• David Lawrence Aitken, BDS MS
• Bonni Gemmell Akalis, MA,LMSW
• Feliza Achacoso Alcid, M.D.
• Denis R Alix, M.D.
• May Alsayab, PHARMACIST

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2023; 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.