Active NPI
Cedar Run Eye Center, PLLC
- Ophthalmology Physician
- Traverse City, MI
National Provider Identifier
1518029909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 4301048021
- Legal business name
- CEDAR RUN EYE CENTER, PLLC
- Practice address
- 3830 W Front St
Traverse City, MI 49684-8153 - Phone
- (231) 929-3888
- Fax
- (231) 929-4365
- NPI assigned
- Dec 14, 2006
- Last updated
- May 11, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Timothy B. Hanley, M.D.
- Title
- Owner
- Phone
- (231) 929-3888
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 4301048021 | MI | |
| Optometrist | 152W00000X | 4901003094 | MI | |
| Optometrist | 152W00000X | 4901003086 | MI | |
| Optometrist | 152W00000X | 4901004107 | MI | |
| Ophthalmology Physician | 207W00000X | 4301048021 | MI | Primary |
Addresses
Primary practice location
3830 W Front St
Traverse City, MI 49684-8153
Mailing address
3830 W Front St
Traverse City, MI 49684-8153
Phone (231) 929-3888
Other identifiers 16
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 900B86347 | Other | MI | BCBS OPTOM GROUP |
| 1134113517 | Other | MI | RAILROAD MEDICARE/CIZEK |
| CG1308 | Other | MI | RAILROAD MEDICARE/TSC |
| 103164508 | Medicaid | MI | |
| 900B86347001 | Other | MI | BCBSM |
| 943166469 | Medicaid | MI | |
| 943166487 | Medicaid | MI | |
| 180B86357 | Other | MI | BCBS TBH |
| 900B86347003 | Other | MI | BCBSM |
| 1020070001 | Other | MI | DMERC REGION B |
| 943166496 | Medicaid | MI | |
| 102022 | Other | MI | PREFERRED CHOICE |
| 1144214180 | Other | MI | RAILROAD MEDICARE/HANLEY |
| 900001413 | Other | MI | PRIORITY - CREC |
| CN1586 | Other | MI | RAILROAD MEDICARE/CREC |
| 1497736102 | Other | MI | RAILROAD MEDICARE/HUMMEL |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Ophthalmology Physician
- Traverse City, MI
- NPI 1144214180
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166054400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1431302400000",
"number": "1518029909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3830 W FRONT ST",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496848153",
"telephone_number": "231-929-3888",
"fax_number": "231-929-4365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3830 W FRONT ST",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496848153",
"telephone_number": "231-929-3888",
"fax_number": "231-929-4365"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CEDAR RUN EYE CENTER, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-14",
"last_updated": "2015-05-11",
"status": "A",
"authorized_official_last_name": "HANLEY",
"authorized_official_first_name": "TIMOTHY",
"authorized_official_middle_name": "B.",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "231-929-3888",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "MI",
"license": "4301048021",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901003094",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901003086",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901004107",
"primary": false
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MI",
"license": "4301048021",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OPTOM GROUP",
"identifier": "900B86347",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE/CIZEK",
"identifier": "1134113517",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE/TSC",
"identifier": "CG1308",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "103164508",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "900B86347001",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "943166469",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "943166487",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS TBH",
"identifier": "180B86357",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "900B86347003",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC REGION B",
"identifier": "1020070001",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "943166496",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CHOICE",
"identifier": "102022",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE/HANLEY",
"identifier": "1144214180",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIORITY - CREC",
"identifier": "900001413",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE/CREC",
"identifier": "CN1586",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE/HUMMEL",
"identifier": "1497736102",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.