Michael E Jonassen, O.D. P.C.
Organization Active NPI Optometrist · Hart, MI
NPI 1568655355 · NPPES record last updated Jul 22, 2009
Key facts
- NPI
- 1568655355
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 4901003163 (MI)
- Legal business name
- MICHAEL E JONASSEN, O.D. P.C.
- Practice address
- 44 S State St
Hart, MI 49420-1123 - Phone
- (231) 873-2575
- Fax
- (231) 873-2593
- NPI assigned
- Aug 24, 2007
- Organization subpart
- No
Authorized official
- Name
- Michael E Jonassen, O.D.
- Title
- President
- Phone
- (231) 873-2575
Practitioners 2
-
Michael Edward Jonassen, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090619000100 | MI | Part B Supplier - Clinic/Group Practice | 0042361750 |
Receives reassigned benefits from 2 practitioners Practice locations: Hart, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 4901003163 | MI | Yes |
| Durable Medical Equipment & Medical Supplies | 332B00000X | 4901003163 | MI |
Addresses
Primary practice location
44 S State St
Hart, MI 49420-1123
Mailing address
44 S State St
Hart, MI 49420-1123
Phone (231) 873-2575
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2644375 | Medicaid | MI |
Other names
- Oceana Eyecare
Other providers in Hart, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.