NPIMap

Organization Active NPI

Cascade Ophthalmology PC

  • Eyewear Supplier
  • Grand Rapids, MI
National Provider Identifier
1508927286
Registry record updated Sep 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
4301070226 Issued in MI
Legal business name
CASCADE OPHTHALMOLOGY PC
Practice address
791 Kenmoor Ave SE
Suite a
Grand Rapids, MI 49546-8625
Phone
(616) 575-8200
Fax
(616) 954-9622
NPI assigned
Dec 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2015

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

Authorized official

Name
Elizabeth H Henry, MDNPI 1598727935
Title
Owner
Phone
(616) 575-8200

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X 4301070226 MI Primary

Addresses

Primary practice location

791 Kenmoor Ave SE
Suite a
Grand Rapids, MI 49546-8625

Mailing address

791 Kenmoor Ave SE
Suite a
Grand Rapids, MI 49546-8625
Phone (616) 575-8200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930057028 MI DME Supplier - Physician - Ophthalmology 3072610112 Practice locations: Grand Rapids, MI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Cascade Ophthalmology PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2855 Michigan St NE
Grand Rapids, MI 49506
Phone (616) 940-3838

791 Kenmoor Ave SE
Grand Rapids, MI 49546

791 Kenmoor Ave SE
Ste A
Grand Rapids, MI 49546
Phone (616) 575-8200

750 E Beltline Ave NE
Ste 201
Grand Rapids, MI 49525
Phone (616) 940-3600

751 Kenmoor Ave SE
Ste C
Grand Rapids, MI 49546
Phone (616) 575-8200

2680 Leonard St NE
Ste 100
Grand Rapids, MI 49525
Phone (616) 224-1110

Practitioners & affiliated clinicians

Practitioners 9

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": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443571200000",
    "number": "1508927286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "791 KENMOOR AVE SE",
            "address_2": "SUITE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468625",
            "telephone_number": "616-575-8200",
            "fax_number": "616-954-9622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "791 KENMOOR AVE SE",
            "address_2": "SUITE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468625",
            "telephone_number": "616-575-8200",
            "fax_number": "616-954-9622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASCADE OPHTHALMOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2015-09-30",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-575-8200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MI",
            "license": "4301070226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2015; 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.