Alice Marie Bacak, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901003231 Issued in MI

Practice address

1088 S Bailey Ave
Suite B
South Haven, MI 49090-9728

Phone

(269) 637-1442

Fax

(269) 637-3801

NPI assigned

Jul 8, 2005

Sex

Female

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 1

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

Specialty

Optometry

Education

Ohio State University - College of Optometry, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

South Haven Eyecare AssociatesGroup PAC ID 5496872681, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• South Haven Eyecare Associates

  • Optometrist
  • South Haven, MI
  • NPI 1083744379
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205280000000",
    "number": "1669470159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1088 S BAILEY AVE",
            "address_2": "SUITE B",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490909728",
            "telephone_number": "269-637-1442",
            "fax_number": "269-637-3801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1088 S BAILEY AVE",
            "address_2": "SUITE B",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490909728",
            "telephone_number": "269-637-1442",
            "fax_number": "269-637-3801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACAK",
        "first_name": "ALICE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-08",
        "last_updated": "2008-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003231",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1994216",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard John Allen, M.D.
• Teresa Ansinn, ANP
• Brook Antonson, OTR/L
• Atrium Countryside LLC
• Atrium South Haven LLC
• John W Baker, D.D.S.
• Linda Lu Baker, LMSW
• Nancy Joan Baker, RN
• Kimberly Banner
• Jamie Barnett

• Optometrist in South Haven, MI
• Providers in South Haven, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.