NPIMap

Organization Active NPI

James P. Serino, O.D. P.C.

  • Optometrist
  • Jackson, MI
National Provider Identifier
1730300377
Registry record updated Jul 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901003057 Issued in MI
Legal business name
JAMES P. SERINO, O.D. P.C.
Practice address
306 W Washington Ave
Suite 104
Jackson, MI 49201-2169
Phone
(517) 783-6928
Fax
(517) 784-9633
NPI assigned
May 1, 2007
Last updated
Jul 1, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2010

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

Authorized official

Name
Dr. James P Serino, O.D.NPI 1205827771
Title
Optometrist
Phone
(517) 783-6928

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 4901003057 MI Primary

Addresses

Primary practice location

306 W Washington Ave
Suite 104
Jackson, MI 49201-2169

Mailing address

306 W Washington Ave
Suite 104
Jackson, MI 49201-2169
Phone (517) 783-6928

Other identifiers 4

IdentifierTypeStateIssuer
5448465OtherMIAETNA
410020815OtherMIPALMETTO GBA RR MEDICARE
200000004902OtherMIPHP OF SOUTH MICHIGAN
900C812040OtherMIBCBS OF MI

National Provider Directory

National Provider Directory

Locations

350 N Wisner St
Ste 104
Jackson, MI 49202
Phone (517) 783-6928

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277942400000",
    "number": "1730300377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 W WASHINGTON AVE",
            "address_2": "SUITE 104",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012169",
            "telephone_number": "517-783-6928",
            "fax_number": "517-784-9633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 W WASHINGTON AVE",
            "address_2": "SUITE 104",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012169",
            "telephone_number": "517-783-6928",
            "fax_number": "517-784-9633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMES P. SERINO, O.D. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2010-07-01",
        "status": "A",
        "authorized_official_last_name": "SERINO",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "517-783-6928",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5448465",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA RR MEDICARE",
            "identifier": "410020815",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP OF SOUTH MICHIGAN",
            "identifier": "200000004902",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MI",
            "identifier": "900C812040",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 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.