Susan Beth Connolly, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004179 Issued in MI

Practice address

4425 W Main St
Kalamazoo, MI 49006-2648

Phone

(269) 345-4425

NPI assigned

May 15, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Portage Family Vision Care, PC

  • Optometrist
  • Portage, MI
  • NPI 1669711438
  Medicare reassignment NPD

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740496595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2481 BAY SIDE AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490027272",
            "telephone_number": "269-324-1251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 W MAIN ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490062648",
            "telephone_number": "269-345-4425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "SUSAN",
        "middle_name": "BETH",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariah Conklin, LMSW
• Levi Jackson Conley, DIPL.AC
• Sarah Conn
• Connected Counseling LLC
• Connections in Hope Counseling LLC
• Mallory Connor
• Lucas Conroy, DC
• Anna Frances Constable
• Constance Brown Hearing and Speech Center
• Mariela Contreras-Barajas

• Optometrist in Kalamazoo, MI
• Providers in Kalamazoo, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.