Active NPI
Carlos Waldo Montanez Lopez, O.D.
- Optometrist
- White Lake, MI
National Provider Identifier
1740449529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901004946
- Practice address
- Walmart Vision Center
9190 Highland Rd.
White Lake, MI 48386 - Phone
- (248) 698-9782
- Fax
- (248) 698-9785
- NPI assigned
- Jun 5, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 188 | PR | |
| Optometrist | 152W00000X | 4901004946 | MI | Primary |
Addresses
Primary practice location
Walmart Vision Center
9190 Highland Rd.
White Lake, MI 48386
Mailing address
P.O. Box 701
Manchester, MI 48158
Phone (734) 355-4673
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901004946 | MI | MD | Optometrist |
| 188 | PR | MD | Specialist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optometrist
- Rochester Hills, MI
- NPI 1366822991
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715299200000",
"number": "1740449529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 701",
"city": "MANCHESTER",
"state": "MI",
"postal_code": "48158",
"telephone_number": "734-355-4673"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "WALMART VISION CENTER",
"address_2": "9190 HIGHLAND RD.",
"city": "WHITE LAKE",
"state": "MI",
"postal_code": "48386",
"telephone_number": "248-698-9782",
"fax_number": "248-698-9785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTANEZ LOPEZ",
"first_name": "CARLOS",
"middle_name": "WALDO",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-05",
"last_updated": "2024-05-10",
"certification_date": "2024-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "PR",
"license": "188",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901004946",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in White Lake, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.