NPIMap

Individual provider Active NPI

Eric Connick, OD

  • Optometrist
  • Traverse City, MI
National Provider Identifier
1659412302
Registry record updated Apr 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901003612 Issued in MI
Practice address
2279 S Airport Rd W
Traverse City, MI 49684-4713
Phone
(231) 932-1520
Fax
(231) 932-1552
NPI assigned
Feb 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901003612 MI Primary

Addresses

Primary practice location

2279 S Airport Rd W
Traverse City, MI 49684-4713

Mailing address

105 W Exchange St
Spring Lake, MI 49456-2024
Phone (616) 846-0620

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Luxottica Retail North America Inc Past Accepting new patients
Luxottica of America Inc Past Accepting new patients

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": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238630400000",
    "number": "1659412302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 W EXCHANGE ST",
            "city": "SPRING LAKE",
            "state": "MI",
            "postal_code": "494562024",
            "telephone_number": "616-846-0620",
            "fax_number": "616-844-6079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2279 S AIRPORT RD W",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496844713",
            "telephone_number": "231-932-1520",
            "fax_number": "231-932-1552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNICK",
        "first_name": "ERIC",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-08",
        "last_updated": "2009-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2009; 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.