Portage Family Vision Care, PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004118 Issued in MI

Legal business name

PORTAGE FAMILY VISION CARE, PC

Practice address

6483 S Westnedge Ave
Portage, MI 49002-3542

Phone

(269) 324-4242

Fax

(269) 324-6145

NPI assigned

Feb 13, 2013

Organization subpart

No

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

Authorized official

Name

Katie Simon, O.D.NPI 1366429581

Title

President/Owner

Phone

(269) 324-4242

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Katie Lee Simon, O.D.

  • Optometrist
  • Portage, MI
  • NPI 1366429581
  Medicare reassignment NPD Authorized official
• Susan Beth Connolly, O.D.

  • Optometrist
  • Kalamazoo, MI
  • NPI 1740496595
  Medicare reassignment NPD
• Laura Nicole Segraves, OD

  • Optometrist
  • Battle Creek, MI
  • NPI 1740929520
  Medicare reassignment NPD

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

{
    "created_epoch": "1360713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360713600000",
    "number": "1669711438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6483 S WESTNEDGE AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490023542",
            "telephone_number": "269-324-4242",
            "fax_number": "269-324-6145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6483 S WESTNEDGE AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490023542",
            "telephone_number": "269-324-4242",
            "fax_number": "269-324-6145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTAGE FAMILY VISION CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-13",
        "last_updated": "2013-02-13",
        "status": "A",
        "authorized_official_last_name": "SIMON",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "269-324-4242",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Portage Audiology Consultants, LLC
• Portage Chiropractic and Wellness Center
• Portage Counseling and Coaching
• Portage Family Dentistry PLLC
• Portage Family Healing LLC
• Portage Family Vision Care, PC
• Portage Life Coaching and Counseling LLP
• Portage Northern Dental
• Portage Opco, LLC
• Portage Pediatric Dentistry PLC

• Optometrist in Portage, MI
• Providers in Portage, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.