NPIMap

Organization Active NPI

Nichols Optical Inc

  • Optometrist
  • Traverse City, MI
National Provider Identifier
1679558712
Registry record updated May 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
NICHOLS OPTICAL INC
Practice address
336 W Front St
Traverse City, MI 49684-2204
Phone
(231) 941-7788
Fax
(231) 941-0893
NPI assigned
Dec 13, 2005
Last updated
May 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2012

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

Authorized official

Name
Ms. Lori A Wirth
Title
General Manager
Phone
(231) 941-7788

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary
Eyewear Supplier 332H00000X NU

Addresses

Primary practice location

336 W Front St
Traverse City, MI 49684-2204

Mailing address

336 W Front St
Traverse City, MI 49684-2204
Phone (231) 941-7788

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040415000386 MI Part B Supplier - Clinic/Group Practice 2466447966 Receives reassigned benefits from 8 practitioners
Practice locations: Mt Pleasant, MI; Traverse City, MI; Midland, MI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Nichols Optical Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

405 E Wackerly St
Midland, MI 48642
Phone (989) 839-5858

4164 E Blue Grass Rd
Mt Pleasant, MI 48858
Phone (989) 772-9481

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336608000000",
    "number": "1679558712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "336 W FRONT ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842204",
            "telephone_number": "231-941-7788",
            "fax_number": "231-941-0893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "336 W FRONT ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842204",
            "telephone_number": "231-941-7788",
            "fax_number": "231-941-0893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICHOLS OPTICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-13",
        "last_updated": "2012-05-10",
        "status": "A",
        "authorized_official_last_name": "WIRTH",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "231-941-7788",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "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 May 10, 2012; 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.