Black and White Look Optical Corporation

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

Organization subpart

No

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

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 5

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

• Lisa Barry, O.D.

  • Optometrist
  • Shelby Township, MI
  • NPI 1174670509
  Medicare reassignment Care Compare group NPD
• Lanny Green, M.D.

  • Ophthalmology Physician
  • Southfield, MI
  • NPI 1972557858
  Medicare reassignment Care Compare group NPD
• Alpa M. Desai, O.D.

  • Optometrist
  • Northville, MI
  • NPI 1013267830
  Medicare reassignment NPD
• Manijeh Shafiemir, OD

  • Optometrist
  • Brighton, MI
  • NPI 1225020043
  Medicare reassignment NPD
• Patrice Coates

  • Prosthetic/Orthotic Supplier
  • Oak Park, MI
  • NPI 1962840124
  NPD

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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3282118",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PIN#",
            "identifier": "900F378590",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NVA PIN#",
            "identifier": "230892",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDWEST HEALTH PIN",
            "identifier": "024599",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TOTAL HEALTH PIN#",
            "identifier": "113750",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CO/OP PIN",
            "identifier": "6719",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS FEDERAL",
            "identifier": "0F37859",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sidney Bishop
• Louis Bitoff Jr., DPM
• Cameron James Bixby, DO
• Mahmoud Bjeijeh, COTA
• Black & White Look Optical Corp
• Black Male Therapist LLC
• Sabrina Diana Black, LLPC
• Brittany Denise Blackburn, REGISTERED NURSE
• Edward L Blackburn
• Jason Barry Blackburn, CRNA

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

• 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.