Active NPI
Dan Lee Fortenbacher, O.D.
- Vision Therapy Optometrist
- St Joseph, MI
National Provider Identifier
1760519946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vision Therapy Optometrist
- License
- 4901002693
- Practice address
- 2908 Division Street
St Joseph, MI 49085 - Phone
- (269) 983-3309
- Fax
- (269) 983-0846
- NPI assigned
- Feb 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 4901002693 | MI | |
| Vision Therapy Optometrist | 152WV0400X | 4901002693 | MI | Primary |
Addresses
Primary practice location
2908 Division Street
St Joseph, MI 49085
Mailing address
2908 Division Street
St Joseph, MI 49085
Phone (269) 983-3309
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 900A165280 | Other | MI | BLUE CROSS BLUE SHIELD OF MICHIGAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901002693 | MI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Holicki Optical Inc | Optometrist | Past | Accepting new patients |
| Saint Joseph Vision Therapy LLC | Vision Therapy | Past | Accepting new patients |
| World Wide Vision Therapy Centers, L.L.C. | Optometrist | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Vision Therapy Optometrist
- Grand Rapids, MI
- NPI 1801275193
-
- Durable Medical Equipment & Medical Supplies
- Coldwater, MI
- NPI 1386637957
Optometrist
-
- Vision Therapy Optometrist
- Saint Joseph, MI
- NPI 1669937926
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432080000000",
"number": "1760519946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2908 DIVISION STREET",
"city": "ST JOSEPH",
"state": "MI",
"postal_code": "49085",
"telephone_number": "269-983-3309",
"fax_number": "269-983-0846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2908 DIVISION STREET",
"city": "ST JOSEPH",
"state": "MI",
"postal_code": "49085",
"telephone_number": "269-983-3309",
"fax_number": "269-983-0846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTENBACHER",
"first_name": "DAN",
"middle_name": "LEE",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-27",
"last_updated": "2015-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901002693",
"primary": false
},
{
"code": "152WV0400X",
"taxonomy_group": "",
"desc": "Optometrist, Vision Therapy",
"state": "MI",
"license": "4901002693",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD OF MICHIGAN",
"identifier": "900A165280",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Joseph, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.