Active NPI
Robert H Walt, OD
- Optometrist
- Hudsonville, MI
National Provider Identifier
1568554251
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901002987
- Practice address
- 3232 Central Blvd
Hudsonville, MI 49426-1439 - Phone
- (616) 669-2530
- Fax
- (616) 669-3646
- NPI assigned
- Sep 29, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901002987 | MI | Primary |
Addresses
Primary practice location
3232 Central Blvd
Hudsonville, MI 49426-1439
Mailing address
3232 Central Blvd
Hudsonville, MI 49426-1439
Phone (616) 669-2530
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MI2987 | Other | MI | EYEMED |
| P25667F | Other | MI | BLUE CARE NETWORK |
| 2708884 | Medicaid | MI |
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
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.
-
- Optometrist
- Hudsonville, MI
- NPI 1972695617
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719187200000",
"number": "1568554251",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3232 CENTRAL BLVD",
"city": "HUDSONVILLE",
"state": "MI",
"postal_code": "494261439",
"telephone_number": "616-669-2530",
"fax_number": "616-669-3646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3232 CENTRAL BLVD",
"city": "HUDSONVILLE",
"state": "MI",
"postal_code": "494261439",
"telephone_number": "616-669-2530",
"fax_number": "616-669-3646"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALT",
"first_name": "ROBERT",
"middle_name": "H",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-29",
"last_updated": "2024-06-24",
"certification_date": "2024-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901002987",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EYEMED",
"identifier": "MI2987",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE NETWORK",
"identifier": "P25667F",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2708884",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hudsonville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.