Shane Patrick King, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004228 Issued in MI

Practice address

523 M L King Ave
Flint, MI 48502-2002

Phone

(810) 238-0925

NPI assigned

Aug 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Optometry

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lapeer County Eye Associates IncGroup PAC ID 6103807169, 7 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Lapeer County Eye Associates Inc

  • Optometrist
  • Lapeer, MI
  • NPI 1235311200
  Medicare reassignment Care Compare group
• Thumb Area Eye Associates

  • Optometrist
  • Lapeer, MI
  • NPI 1861320889
  NPD
• Mei Operations, PLLC

  • Ophthalmology Physician
  • Flint, MI
  • NPI 1316008774
  NPD (past)
• DPT Holdings PLLC

  • Physical Therapist
  • Plainfield, IL
  • NPI 1689648602
  NPD (past)

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261008000000",
    "number": "1528075116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2679 REYNOLDS CIR",
            "city": "COLUMBIAVILLE",
            "state": "MI",
            "postal_code": "484218935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "523 M L KING AVE",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485022002",
            "telephone_number": "810-238-0925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "SHANE",
        "middle_name": "PATRICK",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2009-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004228",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "4901004228",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carrie King
• Hermiyon Myette King
• Iasiah King
• Loni King
• Niyono King
• Adam Michael Kingsbury, PT
• Kingsley L. Sigafus. DC., PC
• Alison Jennifer Kinning, MD
• Wayne K Kinning, M.D.
• Diwakar Kinra, DDS, MS

• Optometrist in Flint, MI
• Providers in Flint, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.