Michael Wallace, O.D.
Individual provider Active NPI Optometrist · Flushing, MI
NPI 1689615346 · NPPES record last updated May 7, 2009
Key facts
- NPI
- 1689615346
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 4901003070 (MI)
- Practice address
- 1379 Flushing Rd
Flushing, MI 48433-2262 - Phone
- (810) 659-3135
- Fax
- (810) 659-0024
- NPI assigned
- Jun 10, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 19
Hospital & facility affiliations 35
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Ferris State College - College of Optometry, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southeast Alaska Regional Health Consortium
E Gay Eye Care PLLC
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
- Southeast Alaska Regional Health Consortium
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in MI, TX, AK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeast Alaska Regional Health Consortium | Current |
Accepting new patients | |
| Southeast Alaska Regional Health Consortium | Current |
Accepting new patients | |
| Norton Sound Health Corporation | Current | Accepting new patients | |
| Southeast Alaska Regional Health Consortium | Current | Accepting new patients | |
| E Gay Eye Care PLLC | Optometrist | Current |
Accepting new patients |
| Tanana Chiefs Conference | Current |
Accepting new patients | |
| Norton Sound Health Corporation | Current |
Accepting new patients | |
| Tanana Chiefs Conference | Current |
Accepting new patients | |
| Norton Sound Health Corporation | Current |
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) 966-8423
2669 Union Lake Rd
Commerce Township, MI 48382
Phone (248) 360-4300
23469 Michigan Ave
Dearborn, MI 48124
Phone (313) 565-5600
Interoperability endpoints
- michael.wallace.1@15989.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901003070 | MI | Yes |
Addresses
Primary practice location
1379 Flushing Rd
Flushing, MI 48433-2262
Mailing address
1379 Flushing Rd
Flushing, MI 48433-2262
Phone (810) 659-3135
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 944885903 | Medicaid | MI | |
| 900B514120 | Other | MI | BLUE CARE NETWORK |
| 2678599 | Medicaid | OH | |
| 900B566350 | Other | MI | BCBS OF MI |
Other providers in Flushing, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 7, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.