Individual provider Active NPI

Holly Wall, O.D.

  • Optometrist
  • Grand Rapids, MI
National Provider Identifier
1518146356
Registry record updated Feb 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901004603 Issued in MI
Practice address
750 E Beltline Ave NE
Grand Rapids, MI 49525-6049
Phone
(616) 949-2600
NPI assigned
Oct 29, 2007
Last updated
Feb 13, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901004603 MI Primary

Addresses

Primary practice location

750 E Beltline Ave NE
Grand Rapids, MI 49525-6049

Mailing address

3667 Running Brook Dr SE
Kentwood, MI 49512-9360
Phone (989) 824-1785

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150212000729 MI Practitioner - Optometry 3971828054 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Blue Sky Vision Eye Care PCGroup PAC ID 8820065618, 51 clinicians

Practice addresses (Care Compare)

750 E Beltline Ave NE
Grand Rapids, MI 49525-6049
Phone (616) 949-2600

Merit-based Incentive Payment System (MIPS)

Final score
75.03 of 100Reported as group
Quality
85.46
Promoting interoperability
100
Improvement activities
40
Cost
31.32

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Sky Vision Eye Care, PC CurrentSince Dec 10, 2014 Accepting new patients
Blue Sky Vision Eye Care, P.C Optometrist CurrentSince Dec 10, 2014 Accepting new patients
Gro Optical, LLC Past Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

511 Wilson Ave NW
Grand Rapids, MI 49534
Phone (616) 301-8663

717 Bagley Ave SE
Grand Rapids, MI 49506
Phone (616) 451-0896

750 E Beltline Ave NE
Grand Rapids, MI 49525
Phone (616) 588-6506

4475 Wilson Ave SW
Grandville, MI 49418
Phone (616) 249-0100

112 S Clay St
Greenville, MI 48838
Phone (616) 754-5667

705 S Greenville West Dr
Ste 201
Greenville, MI 48838
Phone (616) 754-5667

3235 N Wellness Dr
Ste 130
Holland, MI 49424
Phone (616) 994-9586

3235 N Wellness Dr
Ste 210
Holland, MI 49424
Phone (616) 994-9586

537 W Main St
Ionia, MI 48846
Phone (616) 523-1010

80 68th St SE
Kentwood, MI 49548
Phone (616) 391-8220

6050 Northland Dr NE
Ste 100
Rockford, MI 49341
Phone (616) 588-6582

3300 Walker Vw NW
Walker, MI 49544
Phone (616) 588-6570

Interoperability endpoints

  • Direct secure messaging: holly.wall.p1@direct.grophthalmology.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1193616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423785600000",
    "number": "1518146356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3667 RUNNING BROOK DR SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495129360",
            "telephone_number": "989-824-1785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E BELTLINE AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495256049",
            "telephone_number": "616-949-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "HOLLY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-29",
        "last_updated": "2015-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.