Jack Roy, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901005547 Issued in MI

Practice address

30955 Woodward Ave Ste 215
Royal Oak, MI 48073-0801

Phone

(248) 873-0069

NPI assigned

Jun 10, 2021

Last updated

Nov 16, 2023By 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 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

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.

• Visionworks, Inc

  dba Visionworks

  • Optometrist
  • Rochester Hills, MI
  • NPI 1366822991
  Medicare reassignment

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

{
    "created_epoch": "1623283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700092800000",
    "number": "1770150419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30955 WOODWARD AVE STE 215",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480730801",
            "telephone_number": "248-873-0069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30955 WOODWARD AVE STE 215",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480730801",
            "telephone_number": "248-873-0069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROY",
        "first_name": "JACK",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-10",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901005547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terry Roumayah, CRNA
• Nicole Catherine Rowan, OTR/L
• Melissa Courtney Rowland, MD
• Rox Marie
• Anindya Roy, MD
• Royal Oak Family Dentistry
• Royal Oak Family Dentistry PC
• Royal Oak Foot & Ankle, PC
• Royal Oak Medical Center PC
• Royal Oak Medical Center PC

• Optometrist in Royal Oak, MI
• Providers in Royal Oak, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; 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.