Michael J Mavencamp, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

A240 Issued in AK

Practice address

570 Riverstone Way
Ste 3
Fairbanks, AK 99709

Phone

(907) 479-4700

Fax

(907) 457-5596

NPI assigned

Dec 6, 2006

Last updated

Aug 28, 2012By the provider in NPPES

Sex

Male

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 AK

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

Specialty

Optometry

Education

Pacific University - College of Optometry, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

West Valley Vision Center, IncGroup PAC ID 9436234994, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• West Valley Vision Center, Inc

  • Optometrist
  • Fairbanks, AK
  • NPI 1235354515
  Medicare reassignment Care Compare group
• Mavencamp Family Eyecare, Inc

  • Optometrist
  • Fairbanks, AK
  • NPI 1922205061
  Authorized official Same address or phone

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346112000000",
    "number": "1760541676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 RIVERSTONE WAY",
            "address_2": "STE 3",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "99709",
            "telephone_number": "907-479-4700",
            "fax_number": "907-457-5596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 RIVERSTONE WAY",
            "address_2": "STE 3",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "99709",
            "telephone_number": "907-479-4700",
            "fax_number": "907-457-5596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAVENCAMP",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-06",
        "last_updated": "2012-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AK",
            "license": "A240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Matthew
• Heather Suzanna Matumeak
• Jennifer Matz, CCC-SLP
• Amber Doris Maughan, CDC I
• Mavencamp Family Eyecare, Inc
• Ruth Marie Maxwell
• Ellen May, OTR/L
• Heidi Anna May, CNM, ANP
• William Maydwell
• Mayer Clinic Incorporated

• Optometrist in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Optometrist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2012; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.