Individual provider Active NPI

Sophia Yang, OD

  • Optometrist
  • Grosse Pointe Woods, MI
National Provider Identifier
1629429816
Registry record updated Jun 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901004971 Issued in MI
Practice address
19173 Mack Ave
Grosse Pointe Woods, MI 48236-2803
Phone
(313) 882-7883
NPI assigned
Jun 29, 2016
Last updated
Jun 29, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901004971 MI Primary

Addresses

Primary practice location

19173 Mack Ave
Grosse Pointe Woods, MI 48236-2803

Mailing address

118 Cass Ave
Mount Clemens, MI 48043-2204
Phone (586) 468-7370

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
I20160718000844 MI Practitioner - Optometry 1153613831 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Care PlusGroup PAC ID 7214295740, 4 clinicians

Practice addresses (Care Compare)

8470 Main St
Birch Run, MI 48415-9461
Phone (989) 624-2020

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4901004971MIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Timothy R Harris OD PLC Optometrist CurrentSince Feb 6, 2019 Accepting new patients

Locations

1016 S State Rd
Davison, MI 48423
Phone (810) 653-3206

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1467158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467158400000",
    "number": "1629429816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 CASS AVE",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432204",
            "telephone_number": "586-468-7370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19173 MACK AVE",
            "city": "GROSSE POINTE WOODS",
            "state": "MI",
            "postal_code": "482362803",
            "telephone_number": "313-882-7883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YANG",
        "first_name": "SOPHIA",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-29",
        "last_updated": "2016-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grosse Pointe Woods, MI

Sources for this page

Verify at the official NPI Registry.