NPIMap

Individual provider Active NPI

Ellery Isaac

  • Optometrist
  • Bloomfield Hills, MI
National Provider Identifier
1639699135
Registry record updated Jul 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901005069 Issued in MI
Practice address
4114 W Maple Rd
Bloomfield Hills, MI 48301
Phone
(248) 539-4800
NPI assigned
Jun 26, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 15, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901005069 MI Primary

Addresses

Primary practice location

4114 W Maple Rd
Bloomfield Hills, MI 48301

Mailing address

4114 W Maple Rd
Bloomfield Hills, MI 48301-3000
Phone (248) 539-4800

Other practice location 1

24307 Harper Ave
Saint Clair Shores, MI 48080-1271
Phone (586) 775-6733

Other identifiers 1

IdentifierTypeStateIssuer
4901005069MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170829003223 MI Practitioner - Optometry 0244503126 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ferris State College - College of Optometry, 2017
Medicare assignment
May accept Medicare assignment
Group practices
Birmingham Vision CareGroup PAC ID 5193734192, 3 clinicians
Myeyedr Optometry of Michigan LLCGroup PAC ID 7416288949, 58 clinicians

Practice addresses (Care Compare)

4114 W Maple Rd
Bloomfield Township, MI 48301-3000
Phone (248) 539-4800

48873 Hayes Rd
Shelby Township, MI 48315-4405
Phone (586) 247-2121

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 10

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": "1498435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563148800000",
    "number": "1639699135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4114 W MAPLE RD",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483013000",
            "telephone_number": "248-539-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4114 W MAPLE RD",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "48301",
            "telephone_number": "248-539-4800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24307 Harper Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Clair Shores",
            "state": "MI",
            "postal_code": "480801271",
            "country_code": "US",
            "telephone_number": "586-775-6733",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ISAAC",
        "first_name": "ELLERY",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-26",
        "last_updated": "2019-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901005069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4901005069",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield Hills, MI

Sources for this page

Verify at the official NPI Registry.