Professional Optical LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

PROFESSIONAL OPTICAL LLC

Practice address

560 W Mitchell St
Suite#204
Petoskey, MI 49770-2275

Phone

(231) 487-0171

NPI assigned

Dec 13, 2006

Last updated

Jul 17, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. David DziakNPI 1417183591

Title

Member

Phone

(231) 487-0171

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David Kenneth Dziak, ABOC/NCLEC

  • Optician
  • Petoskey, MI
  • NPI 1417183591
  NPD (past) Authorized official
• Debra Lin Denton, O.D.

  • Optometrist
  • Petoskey, MI
  • NPI 1124053954
  NPD (past)
• Lyndsay Leigh Olmstead, O.D.

  • Optometrist
  • Petoskey, MI
  • NPI 1922363589
  NPD (past)
• Ashley J Rossman, D.O.

  • Ophthalmology Physician
  • Petoskey, MI
  • NPI 1396184776
  NPD (past)

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216252800000",
    "number": "1790846533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 W MITCHELL ST",
            "address_2": "SUITE#204",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702275",
            "telephone_number": "231-487-0171",
            "fax_number": "231-487-0690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 W MITCHELL ST",
            "address_2": "SUITE#204",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702275",
            "telephone_number": "231-487-0171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL OPTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2008-07-17",
        "status": "A",
        "authorized_official_last_name": "DZIAK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "231-487-0171",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI BCBS",
            "identifier": "540B411030",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Eyewear Supplier in Petoskey, MI
• Providers in Petoskey, MI by specialty
• Eyewear Supplier in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.