Professional Eyecare of West Michigan LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004426 Issued in MI

Legal business name

PROFESSIONAL EYECARE OF WEST MICHIGAN LLC

Practice address

6750 Kalamazoo Ave SE
Suite C
Grand Rapids, MI 49508-7897

Phone

(616) 656-0505

Fax

(616) 682-5163

NPI assigned

Oct 1, 2009

Last updated

Jun 8, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Troy Lebaron, O.D.NPI 1124210091

Title

Member

Phone

(616) 334-9255

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Troy Jonathan Lebaron, O.D.

  • Optometrist
  • Grand Rapids, MI
  • NPI 1124210091
  Authorized official Same address or phone

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

{
    "created_epoch": "1254355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275955200000",
    "number": "1467786822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6750 KALAMAZOO AVE SE",
            "address_2": "SUITE C",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495087897",
            "telephone_number": "616-656-0505",
            "fax_number": "616-682-5163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6750 KALAMAZOO AVE SE",
            "address_2": "SUITE C",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495087897",
            "telephone_number": "616-656-0505",
            "fax_number": "616-682-5163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL EYECARE OF WEST MICHIGAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-01",
        "last_updated": "2010-06-08",
        "status": "A",
        "authorized_official_last_name": "LEBARON",
        "authorized_official_first_name": "TROY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "616-334-9255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie Jean Proctor, LMSW
• Kimberly Proctor, LLMSW
• Madison Proctor
• Professional Dentalcare Associates, PLLC
• Professional Experienced Assistant Caring for the Elderly of Mind
• Professional Financial Services (Clinica Santa Maria)
• Professional Financial Services
• Professional Hands LLC
• Professional Pain Management PC
• Professional Rehabilitation Services, Inc. (Rebound Home and Community Therapy)

• Optometrist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2010; 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.