Organization Active NPI

Black and White Look Optical Corporation

  • Optometrist
  • Southfield, MI
National Provider Identifier
1679660849
Registry record updated Mar 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
BLACK AND WHITE LOOK OPTICAL CORPORATION
Practice address
15675 W Ten Mile Rd
Southfield, MI 48075-2188
Phone
(248) 557-6444
Fax
(248) 557-6501
NPI assigned
Oct 6, 2006
Last updated
Mar 8, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2013

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

Authorized official

Name
Ms. Phyllis Frye
Title
Office Manager
Phone
(248) 557-6444

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X MI Primary

Addresses

Primary practice location

15675 W Ten Mile Rd
Southfield, MI 48075-2188

Mailing address

15675 W Ten Mile Rd
Southfield, MI 48075-2188
Phone (248) 557-6444

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060109000451 MI Part B Supplier - Clinic/Group Practice 7911920673 Receives reassigned benefits from 4 practitioners
Practice locations: Detroit, MI; Eastpointe, MI; Southfield, MI

National Provider Directory

National Provider Directory

Locations

1514 U St NW
Washington, DC 20009
Phone (202) 299-9108

29201 Telegraph Rd
Ste 602
Southfield, MI 48034
Phone (248) 357-5390

Practitioners & affiliated clinicians

Practitioners 5

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": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362700800000",
    "number": "1679660849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15675 W TEN MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752188",
            "telephone_number": "248-557-6444",
            "fax_number": "248-557-6501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15675 W TEN MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752188",
            "telephone_number": "248-557-6444",
            "fax_number": "248-557-6501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK AND WHITE LOOK OPTICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2013-03-08",
        "status": "A",
        "authorized_official_last_name": "FRYE",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "248-557-6444",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 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.