NPIMap

Organization Active NPI

Professional Contact Lens Clinic Inc.

  • Optometrist
  • Farmington Hills, MI
National Provider Identifier
1487799599
Registry record updated Jan 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2356 Issued in MI
Legal business name
PROFESSIONAL CONTACT LENS CLINIC INC.
Practice address
30660 W 12 Mile Rd
Farmington Hills
Farmington Hills, MI 48334-3808
Phone
(248) 737-3937
Fax
(248) 737-2816
NPI assigned
Feb 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2012

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

Authorized official

Name
Dr. Rudolph Sam Demercurio, O.D.
Title
President
Phone
(248) 737-3937

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2356 MI Primary

Addresses

Primary practice location

30660 W 12 Mile Rd
Farmington Hills
Farmington Hills, MI 48334-3808

Mailing address

30660 W 12 Mile Rd
Farmington Hills
Farmington Hills, MI 48334-3808
Phone (248) 737-3937

Other identifiers 1

IdentifierTypeStateIssuer
MI4432OtherMIMEDICARE PTAN

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325808000000",
    "number": "1487799599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30660 W 12 MILE RD",
            "address_2": "FARMINGTON HILLS",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483343808",
            "telephone_number": "248-737-3937",
            "fax_number": "248-737-2816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30660 W 12 MILE RD",
            "address_2": "FARMINGTON HILLS",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483343808",
            "telephone_number": "248-737-3937",
            "fax_number": "248-737-2816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL CONTACT LENS CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2012-01-06",
        "status": "A",
        "authorized_official_last_name": "DEMERCURIO",
        "authorized_official_first_name": "RUDOLPH",
        "authorized_official_middle_name": "SAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-737-3937",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "2356",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "MI4432",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington Hills, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2012; 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.