Individual provider Active NPI

Maria E Sicco, OD

  • Optometrist
  • Grand Rapids, MI
National Provider Identifier
1659931020
Registry record updated Jun 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901005385 Issued in MI
Practice address
100 Cherry St SE
Grand Rapids, MI 49503-4526
Phone
(616) 965-8200
NPI assigned
Jun 18, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 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 4901005385 MI Primary

Addresses

Primary practice location

100 Cherry St SE
Grand Rapids, MI 49503-4526

Mailing address

100 Cherry St SE
Grand Rapids, MI 49503-4526
Phone (616) 965-8200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20200728003730 CO Practitioner - Optometry 6305171208 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Abba Eye Care PC Optometrist CurrentSince Jul 6, 2020 Accepting new patients
Abba Eye Care PC Optometrist CurrentSince Jul 6, 2020 Accepting new patients

Locations

6220 Woodmen Park Vw
Colorado Springs, CO 80923
Phone (719) 634-2020

4430 N Nevada Ave
Colorado Springs, CO 80907
Phone (719) 635-2020

1813 N Circle Dr
Colorado Springs, CO 80909
Phone (719) 632-2020

1130 Lake Plaza Dr
Ste 130
Colorado Springs, CO 80906
Phone (719) 578-2020

7975 Fountain Mesa Rd
Fountain, CO 80817
Phone (719) 573-2020

314 Colorado Ave
La Junta, CO 81050
Phone (303) 544-8331

2800 Cornerstone Dr
Ste A6
Pagosa Springs, CO 81147
Phone (970) 731-4300

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": "1560816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560816000000",
    "number": "1659931020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CHERRY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034526",
            "telephone_number": "616-965-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CHERRY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034526",
            "telephone_number": "616-965-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SICCO",
        "first_name": "MARIA",
        "middle_name": "E",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-18",
        "last_updated": "2019-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901005385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.