Individual provider Active NPI

Michael John Zysik, O.D.

  • Optometrist
  • Perrysburg, OH
National Provider Identifier
1619961208
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4999/T1869 Issued in OH
Practice address
850 Commerce Dr
Perrysburg, OH 43551-5240
Phone
(419) 872-4477
Fax
(419) 872-6555
NPI assigned
Sep 9, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4999/T1869 OH Primary

Addresses

Primary practice location

850 Commerce Dr
Perrysburg, OH 43551-5240

Mailing address

850 Commerce Dr
Perrysburg, OH 43551-5240
Phone (419) 872-4477

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20060105000482 OH Practitioner - Optometry 6800812009 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aeg Ohio Professional PCGroup PAC ID 7618207036, 80 clinicians

Practice addresses (Care Compare)

33541 Aurora Rd
Solon, OH 44139-3705
Phone (440) 248-2020

850 Commerce Dr
Perrysburg, OH 43551-5240
Phone (419) 872-4477

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery29

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4999/T1869OHMDOptometrist
4999OHMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Aeg Ohio Professional PC Optometrist CurrentSince Oct 1, 2020 Accepting new patients
Aeg Ohio Professional PC Optometrist CurrentSince Oct 1, 2020 Accepting new patients

Locations

850 Commerce Dr
Perrysburg, OH 43551
Phone (419) 872-4477

33541 Aurora Rd
Solon, OH 44139
Phone (440) 248-2020

Organizations & group practices 2

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": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619961208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 COMMERCE DR",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435515240",
            "telephone_number": "419-872-4477",
            "fax_number": "419-872-6555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 COMMERCE DR",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435515240",
            "telephone_number": "419-872-4477",
            "fax_number": "419-872-6555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZYSIK",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "4999/T1869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perrysburg, OH

Sources for this page

Verify at the official NPI Registry.