Gene Fonger, O.D.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

4901002505 Issued in MI

Practice address

144 Monroe Center St NW
Grand Rapids, MI 49503-2802

Phone

(616) 459-0641

Fax

(616) 459-0621

NPI assigned

May 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372204800000",
    "number": "1649226499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 MONROE CENTER ST NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032802",
            "telephone_number": "616-459-0641",
            "fax_number": "616-459-0621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 MONROE CENTER ST NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032802",
            "telephone_number": "616-459-0641",
            "fax_number": "616-459-0621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONGER",
        "first_name": "GENE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2013-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MI",
            "license": "4901002505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADMINASTAR",
            "identifier": "5474550001",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN #",
            "identifier": "900D114850",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5041964",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenneth David Follett III
• David Andrew Folt, M.D.
• Bobga S Fomunung, MD
• Antonia Bih Fomunyam Nyongabsen
• Christina Fong
• James Fongers, MSW, LMSW
• Katie Fontaine, PT, DPT
• Ryan K Fontanilla, MD
• Lawrence T. Foody, M.D.
• Foot & Ankle Specialists of West Michigan P L L C

• Corneal and Contact Management Optometrist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Corneal and Contact Management Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.