NPIMap

Organization Active NPI

B. Jeffrey Pulk, P.C.

  • Optometrist
  • Traverse City, MI
National Provider Identifier
1528237690
Registry record updated Feb 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901004124 Issued in MI
Legal business name
B. JEFFREY PULK, P.C.
Doing business as
Old Town Optical
Practice address
515 S Union St
Traverse City, MI 49684-3246
Phone
(231) 946-0333
Fax
(231) 946-1665
NPI assigned
Feb 22, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2008

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

Authorized official

Name
Bernard Jeffrey Pulk, O.D.
Title
Ceo
Phone
(231) 946-0333

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 4901004124 MI Primary
Corneal and Contact Management OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WC0802X 4901004124 MI
Sports Vision OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WS0006X 4901004124 MI
Vision Therapy OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WV0400X 4901004124 MI

Addresses

Primary practice location

515 S Union St
Traverse City, MI 49684-3246

Mailing address

515 S Union St
Traverse City, MI 49684-3246
Phone (231) 946-0333

Other identifiers 1

IdentifierTypeStateIssuer
4351130MedicaidMI

Other names 1

  • Old Town Optical Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1203638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203638400000",
    "number": "1528237690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 S UNION ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496843246",
            "telephone_number": "231-946-0333",
            "fax_number": "231-946-1665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 S UNION ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496843246",
            "telephone_number": "231-946-0333",
            "fax_number": "231-946-1665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "B. JEFFREY PULK, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-22",
        "last_updated": "2008-02-22",
        "status": "A",
        "authorized_official_last_name": "PULK",
        "authorized_official_first_name": "BERNARD",
        "authorized_official_middle_name": "JEFFREY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "231-946-0333",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004124",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MI",
            "license": "4901004124",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Sports Vision",
            "state": "MI",
            "license": "4901004124",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": "MI",
            "license": "4901004124",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4351130",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Old Town Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.