Keith Ronald Moulds, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004021 Issued in MI

Practice address

4643 Alpine Ave NW
A
Comstock Park, MI 49321-8179

Phone

(616) 784-8700

Fax

(616) 784-8708

NPI assigned

Nov 2, 2005

Last updated

May 30, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Ferris State College - College of Optometry, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ferris State UniversityGroup PAC ID 3971572124, 27 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ferris State University

  dba University Eye Center

  • Optometrist
  • Big Rapids, MI
  • NPI 1871510859
  Medicare reassignment Care Compare group NPD
• Keith R Moulds OD PC

  dba Alphine Family Eyecare

  • Optometrist
  • Comstock Park, MI
  • NPI 1275516155
  Medicare reassignment NPD Authorized official
• Ferris State University

  dba University Eye Center

  • Ophthalmology Physician
  • Big Rapids, MI
  • NPI 1477574101
  NPD

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338336000000",
    "number": "1487645065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4643 ALPINE AVE NW",
            "address_2": "A",
            "city": "COMSTOCK PARK",
            "state": "MI",
            "postal_code": "493218179",
            "telephone_number": "616-784-8700",
            "fax_number": "616-784-8708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4643 ALPINE AVE NW",
            "address_2": "A",
            "city": "COMSTOCK PARK",
            "state": "MI",
            "postal_code": "493218179",
            "telephone_number": "616-784-8700",
            "fax_number": "616-784-8708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOULDS",
        "first_name": "KEITH",
        "middle_name": "RONALD",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2012-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "944431615",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mi Smiles Dental Comstock Park PLC
• Michigan Moves Performance and Rehabilitation
• Anne Marie Moore
• Michael Allen Moore, PA-C
• Janette M Morin-Sims, MD
• Mount Health Services LLC
• Ashley Musk
• Cynthia Rae Musky
• Margaret Normandin, PA-C
• Rebecca Joy Paige-Guerra, P.A.

• Optometrist in Comstock Park, MI
• Providers in Comstock Park, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.