Individual provider Active NPI

Gary Stolicker, O.D.

  • Optometrist
  • Lansing, MI
National Provider Identifier
1811195357
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901004432 Issued in MI
Practice address
5726 W Saginaw Hwy
Lansing, MI 48917-2457
Phone
(517) 327-0019
NPI assigned
Jul 6, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901004432 MI Primary

Addresses

Primary practice location

5726 W Saginaw Hwy
Lansing, MI 48917-2457

Mailing address

4099 Pheasant Run
Holt, MI 48842-8772
Phone (517) 272-1912

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20080709000106 MI Practitioner - Optometry 3779655782 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ferris State College - College of Optometry, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1621 E M
Suite 21
Owosso, MI 48867-9053
Phone (989) 729-1519

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4901004432MIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Eye Clinic, PLLC CurrentSince Sep 4, 2012 Accepting new patients
Luxottica Retail North America Inc Past Accepting new patients
Luxottica of America Inc. Past Accepting new patients

Locations

1621 E M 21
Owosso, MI 48867
Phone (989) 723-2656

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1183680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811195357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4099 PHEASANT RUN",
            "city": "HOLT",
            "state": "MI",
            "postal_code": "488428772",
            "telephone_number": "517-272-1912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5726 W SAGINAW HWY",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489172457",
            "telephone_number": "517-327-0019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOLICKER",
        "first_name": "GARY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lansing, MI

Sources for this page

Verify at the official NPI Registry.