Lakeville Eye Care Center, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

LAKEVILLE EYE CARE CENTER, INC.

Practice address

9575 State Rd
Millington, MI 48746-9482

Phone

(989) 871-9552

Fax

(989) 871-9554

NPI assigned

Jun 13, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Teresa Marie Ennis-Decker, O.D.NPI 1154322956

Title

Owner

Phone

(989) 871-9552

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Teresa Marie Ennis-Decker, O.D.

  • Optometrist
  • Millington, MI
  • NPI 1154322956
  Medicare reassignment NPD Authorized official
• Jennifer Lynn Smalley-Huber, O.D.

  • Optometrist
  • Saginaw, MI
  • NPI 1275682015
  Medicare reassignment NPD

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358380800000",
    "number": "1770526436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9575 STATE RD",
            "city": "MILLINGTON",
            "state": "MI",
            "postal_code": "487469482",
            "telephone_number": "989-871-9552",
            "fax_number": "989-871-9554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9575 STATE RD",
            "city": "MILLINGTON",
            "state": "MI",
            "postal_code": "487469482",
            "telephone_number": "989-871-9552",
            "fax_number": "989-871-9554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEVILLE EYE CARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2013-01-17",
        "status": "A",
        "authorized_official_last_name": "ENNIS-DECKER",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-871-9552",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "944743819",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Ewald
• Raeann Henderson
• Sandra Hurst, MBA LBSW
• Marie E Kenny, DO
• Shianne Kozma, CST, FA
• Caitlin Lawrence
• Rachel Jo Levault
• Marlette Regional Hospital
• Marlette Regional Hospital
• Anne Marie McCall, NP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.