NPIMap

Individual provider Active NPI

Michael Wallace, O.D.

  • Optometrist
  • Flushing, MI
National Provider Identifier
1689615346
Registry record updated May 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901003070 Issued in MI
Practice address
1379 Flushing Rd
Flushing, MI 48433-2262
Phone
(810) 659-3135
Fax
(810) 659-0024
NPI assigned
Jun 10, 2006
Last updated
May 7, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901003070 MI Primary

Addresses

Primary practice location

1379 Flushing Rd
Flushing, MI 48433-2262

Mailing address

1379 Flushing Rd
Flushing, MI 48433-2262
Phone (810) 659-3135

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, TX, AK3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20050719001073 MI Practitioner - Optometry 0648207910 Reassigns benefits to 2 organizations
I20230718001691 TX Practitioner - Optometry 0648207910 Reassigns benefits to 2 organizations
I20250723003153 AK Practitioner - Optometry 0648207910 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ferris State College - College of Optometry, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
E Gay Eye Care PLLCGroup PAC ID 5698041317, 3 clinicians

Practice addresses (Care Compare)

1204 Seward Ave
Searhc 1204 Behavioral Health Sitka
Sitka, AK 99835-7359
Phone (907) 966-8611

1206 Seward Ave
Searhc 1206 Behavioral Health Sitka
Sitka, AK 99835-7359
Phone (907) 966-8611

1209 Seward Ave
Searhc 1209 Behavioral
Sitka, AK 99835-7359
Phone (907) 966-8611

131 1St S St
Searchc Haines Medical Clinic
Haines, AK 99827-0389
Phone (907) 766-2521

222 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411

227 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411

23469 Michigan Ave
Dearborn, MI 48124-1908
Phone (313) 565-5600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Norton Sound Health Corporation CurrentSince Jun 9, 2025 Accepting new patients
Norton Sound Health Corporation Current Accepting new patients
Southeast Alaska Regional Health Consortium Current Accepting new patients
Norton Sound Health Corporation CurrentSince Jun 9, 2025 Accepting new patients
Southeast Alaska Regional Health Consortium CurrentSince Jul 10, 2025 Accepting new patients
E Gay Eye Care PLLC Optometrist CurrentSince Oct 1, 2025 Accepting new patients
Southeast Alaska Regional Health Consortium CurrentSince Jul 10, 2025 Accepting new patients
Tanana Chiefs Conference CurrentSince Jul 5, 2023 Accepting new patients
Tanana Chiefs Conference CurrentSince Jul 5, 2023 Accepting new patients
South East Alaska Regional Health Consortium Past Accepting new patients

Locations

1717 W Cowles St
Fairbanks, AK 99701
Phone (907) 452-6682

37 Chilkat Ave
Haines, AK 99827
Phone (907) 463-4040

3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000

222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8519

2669 Union Lake Rd
Commerce Township, MI 48382
Phone (248) 360-4300

23469 Michigan Ave
Dearborn, MI 48124
Phone (313) 565-5600

Interoperability endpoints

  • Direct secure messaging: michael.wallace.1@15989.direct.athenahealth.com

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 35

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1241654400000",
    "number": "1689615346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1379 FLUSHING RD",
            "city": "FLUSHING",
            "state": "MI",
            "postal_code": "484332262",
            "telephone_number": "810-659-3135",
            "fax_number": "810-659-0024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1379 FLUSHING RD",
            "city": "FLUSHING",
            "state": "MI",
            "postal_code": "484332262",
            "telephone_number": "810-659-3135",
            "fax_number": "810-659-0024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-10",
        "last_updated": "2009-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, MI

Sources for this page

Verify at the official NPI Registry.