NPIMap

Organization Active NPI

Michael Griffin PC

  • Optometrist
  • Dothan, AL
National Provider Identifier
1497052591
Registry record updated Aug 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
S774-TA-431 Issued in AL
Legal business name
MICHAEL GRIFFIN PC
Practice address
1450 Ross Clark Cir
Suite 400
Dothan, AL 36301-4765
Phone
(334) 479-0043
Fax
(334) 792-8630
NPI assigned
Feb 25, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2021

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

Authorized official

Name
Michael Alvin Griffin, O.D.NPI 1639103799
Title
Owner
Phone
(334) 479-0043

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X S774-TA-431 AL Primary
OpticianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 156FX1800X S774-TA-431 AL

Addresses

Primary practice location

1450 Ross Clark Cir
Suite 400
Dothan, AL 36301-4765

Mailing address

206 Medical Care Way
Suite 400
Dothan, AL 36303-4765
Phone (334) 794-8797

Other identifiers 1

IdentifierTypeStateIssuer
127693MedicaidAL

Other names 1

  • Dothan Optometric Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150629001128 AL Part B Supplier - Clinic/Group Practice 0143471946 Receives reassigned benefits from 4 practitioners
Practice locations: Dothan, AL

National Provider Directory

National Provider Directory

Locations

102 Doctors Dr
#2
Dothan, AL 36301
Phone (334) 479-0043

1450 Ross Clark Cir
Ste 400
Dothan, AL 36301
Phone (334) 305-0400

206 Medical Care Way
Ste 400
Dothan, AL 36303

206 Medical Care Way
Dothan, AL 36303
Phone (334) 479-0043

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1298592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630368000000",
    "number": "1497052591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 MEDICAL CARE WAY",
            "address_2": "SUITE 400",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363034765",
            "telephone_number": "334-794-8797",
            "fax_number": "334-479-0658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 ROSS CLARK CIR",
            "address_2": "SUITE 400",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363014765",
            "telephone_number": "334-479-0043",
            "fax_number": "334-792-8630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL GRIFFIN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-25",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-13",
        "status": "A",
        "authorized_official_last_name": "GRIFFIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ALVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "334-479-0043",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S774-TA-431",
            "primary": true
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "AL",
            "license": "S774-TA-431",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127693",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dothan Optometric Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dothan Optometric Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.