Michael J. Bangert O.D. Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

56000085A Issued in IN

Legal business name

MICHAEL J. BANGERT O.D. INC.

Doing business as

Family EyeCare Associates

Practice address

4626 W Jefferson Blvd
Fort Wayne, IN 46804-6826

Phone

(260) 432-5502

Fax

(260) 432-8415

NPI assigned

Jan 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Michael James Bangert, O.D.

Title

Owner

Phone

(260) 432-5502

Specialties & licenses 1

Addresses

Other names 1

• Family EyeCare Associates Doing business as

Locations

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375142400000",
    "number": "1689720054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4626 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046826",
            "telephone_number": "260-432-5502",
            "fax_number": "260-432-8415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4626 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046826",
            "telephone_number": "260-432-5502",
            "fax_number": "260-432-8415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J. BANGERT O.D. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2013-07-30",
        "status": "A",
        "authorized_official_last_name": "BANGERT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-432-5502",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": "56000085A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family EyeCare Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2013; 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.