Portage Family Vision Care, PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004152 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

Oct 28, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Deanna Lyn Mayo, OD

Title

OD/Owner

Phone

(269) 324-4242

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1288224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288224000000",
    "number": "1679873343",
    "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": "2010-10-28",
        "last_updated": "2010-10-28",
        "status": "A",
        "authorized_official_last_name": "MAYO",
        "authorized_official_first_name": "DEANNA",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "OD/OWNER",
        "authorized_official_telephone_number": "269-324-4242",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4929042",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 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
• Portage Pharmacy, Inc.

• 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 Oct 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.