NPIMap

Organization Active NPI

Michigan Ophthalmology Specialists, PLLC

  • Ophthalmology Physician
  • Pontiac, MI
National Provider Identifier
1770239691
Registry record updated Mar 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MICHIGAN OPHTHALMOLOGY SPECIALISTS, PLLC
Practice address
44555 Woodward Ave Ste 203
Pontiac, MI 48341-5033
Phone
(248) 334-4931
NPI assigned
Mar 1, 2022
Last updated
Mar 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2022

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

Authorized official

Name
Beverly Zwicker
Title
Credentialing Manager
Phone
(248) 395-5175

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

44555 Woodward Ave Ste 203
Pontiac, MI 48341-5033

Mailing address

30150 Telegraph Rd Ste 271
Bingham Farms, MI 48025-4521
Phone (248) 395-5175

Other practice location 1

6875 Dixie Hwy
Clarkston, MI 48346-5106
Phone (248) 625-5922

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230215000736 MI DME Supplier - Physician - Optometrist 3577557131 Practice locations: Pontiac, MI

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Michigan Ophthalmology Specialists44555 Woodward Ave, Pontiac, MI 48341-5033(248) 334-4931 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Feb 16, 2000

National Provider Directory

National Provider Directory
Tax ID family
Michigan Ophthalmology Specialists PLLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6875 Dixie Hwy
Clarkston, MI 48346
Phone (248) 625-5922

NPI Registry JSON

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

{
    "created_epoch": "1646092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646092800000",
    "number": "1770239691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30150 TELEGRAPH RD STE 271",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480254521",
            "telephone_number": "248-395-5175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44555 WOODWARD AVE STE 203",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483415033",
            "telephone_number": "248-334-4931"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6875 Dixie Hwy",
            "address_purpose": "LOCATION",
            "city": "Clarkston",
            "state": "MI",
            "postal_code": "483465106",
            "country_code": "US",
            "telephone_number": "248-625-5922",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MICHIGAN OPHTHALMOLOGY SPECIALISTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-01",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A",
        "authorized_official_last_name": "ZWICKER",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "248-395-5175"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pontiac, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.