NPIMap

Organization Active NPI

Fortney Eyecare Associates Inc

  • Optometrist
  • Dearborn, MI
National Provider Identifier
1508970310
Registry record updated Apr 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901001955 Issued in MI
Legal business name
FORTNEY EYECARE ASSOCIATES INC
Practice address
23469 Michigan Avenue
Dearborn, MI 48124
Phone
(313) 565-5600
Fax
(313) 562-3000
NPI assigned
Aug 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2014

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

Authorized official

Name
Robert Taylor
Title
VP
Phone
(313) 565-5600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 4901001955 MI Primary

Addresses

Primary practice location

23469 Michigan Avenue
Dearborn, MI 48124

Mailing address

23469 Michigan Avenue
Dearborn, MI 48124
Phone (313) 565-5600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050127000371 MI Part B Supplier - Clinic/Group Practice 6507816584 Receives reassigned benefits from 8 practitioners
Practice locations: Dearborn, MI
O20100930032709 MI DME Supplier - Physician - Optometrist 6507816584 Practice locations: Dearborn, MI

National Provider Directory

National Provider Directory
Tax ID family
Fortney Eyecare Associates Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 8

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": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397001600000",
    "number": "1508970310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23469 MICHIGAN AVENUE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "48124",
            "telephone_number": "313-565-5600",
            "fax_number": "313-562-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23469 MICHIGAN AVENUE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "48124",
            "telephone_number": "313-565-5600",
            "fax_number": "313-562-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORTNEY EYECARE ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2014-04-09",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "313-565-5600"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901001955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2014; 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.