Active NPI
Three Rivers Eyecare PC
- Eyewear Supplier
- Otsego, MI
National Provider Identifier
1497812150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Eyewear Supplier
- Legal business name
- THREE RIVERS EYECARE PC
- Doing business as
- Sussex Vision Center
- Practice address
- 123 S Fair Street
Otsego, MI 49078 - Phone
- (269) 694-9462
- Fax
- (269) 694-5826
- NPI assigned
- Jan 2, 2007
- Organization subpart
- Yes
- Parent organization
- THREE RIVERS EYECARE PC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michael L Sussex, OD
- Title
- President Owner
- Phone
- (269) 694-9462
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Eyewear Supplier | 332H00000X | Primary |
Addresses
Primary practice location
123 S Fair Street
Otsego, MI 49078
Mailing address
56847 N Main St
Three Rivers, MI 49036
Phone (269) 273-5825
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 945191120 | Medicaid | MI | |
| 900G510070 | Other | MI | BCBS |
| 944696853 | Medicaid | MI |
Other names 1
- Sussex Vision Center
National Provider Directory
National Provider Directory- Part of
- Three Rivers Eye Care P
Locations
1525 Michigan Ave W
Ste 15A
Battle Creek, MI 49037
Phone (269) 964-9200
1525 Michigan Ave W
#15A
Battle Creek, MI 49037
Phone (269) 964-9200
717 Bagley Ave SE
Grand Rapids, MI 49506
Phone (616) 451-0896
706 S Centerville Rd
Sturgis, MI 49091
Phone (269) 241-2700
3300 Walker Vw NW
Walker, MI 49544
Phone (616) 588-6570
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1279584000000",
"number": "1497812150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "56847 N MAIN ST",
"city": "THREE RIVERS",
"state": "MI",
"postal_code": "49036",
"telephone_number": "269-273-5825",
"fax_number": "269-279-6010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "123 S FAIR STREET",
"city": "OTSEGO",
"state": "MI",
"postal_code": "49078",
"telephone_number": "269-694-9462",
"fax_number": "269-694-5826"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "THREE RIVERS EYECARE PC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "THREE RIVERS EYECARE PC",
"enumeration_date": "2007-01-02",
"last_updated": "2010-07-20",
"status": "A",
"authorized_official_last_name": "SUSSEX",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "PRESIDENT OWNER",
"authorized_official_telephone_number": "269-694-9462",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "332H00000X",
"taxonomy_group": "",
"desc": "Eyewear Supplier",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "945191120",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "900G510070",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "944696853",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Sussex Vision Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Otsego, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 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.