Individual provider Active NPI

Carlie Crank

  • Optometrist
  • Grand Rapids, MI
National Provider Identifier
1568152239
Registry record updated Jun 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901005677 Issued in MI
Practice address
6748 Kalamazoo Ave SE
Grand Rapids, MI 49508-7032
Phone
(616) 275-2020
NPI assigned
May 8, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901005677 MI Primary

Addresses

Primary practice location

6748 Kalamazoo Ave SE
Grand Rapids, MI 49508-7032

Mailing address

6748 Kalamazoo Ave SE
Grand Rapids, MI 49508-7032

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
I20230621000894 MI Practitioner - Optometry 0042678260 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Family Eye Care PCGroup PAC ID 0143519256, 2 clinicians

Practice addresses (Care Compare)

6748 Kalamazoo Ave SE
Grand Rapids, MI 49508-7032
Phone (616) 275-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Family Eye Care PC. Optometrist CurrentSince Jun 5, 2023 Accepting new patients

Locations

6748 Kalamazoo Ave SE
Grand Rapids, MI 49508
Phone (616) 275-2020

2350 32nd St SE
Kentwood, MI 49508
Phone (616) 243-0007

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1683504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1568152239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6748 KALAMAZOO AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495087032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6748 KALAMAZOO AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495087032",
            "telephone_number": "616-275-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRANK",
        "first_name": "CARLIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-08",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901005677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.