Phillip a. Kohanov O.D. PC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

PHILLIP A. KOHANOV O.D. PC

Practice address

3833 24TH Ave
Fort Gratiot, MI 48059-4100

Phone

(810) 985-5600

Fax

(810) 985-5740

NPI assigned

Nov 15, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Phillip A. Kohanov, O.D.NPI 1184615742

Title

Optometrist

Phone

(810) 985-5600

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

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

• Phillip A Kohanov, O.D.

  • Optometrist
  • Fort Gratiot, MI
  • NPI 1184615742
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338854400000",
    "number": "1821279159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3833 24TH AVE",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480594100",
            "telephone_number": "810-985-5600",
            "fax_number": "810-985-5740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3833 24TH AVE",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480594100",
            "telephone_number": "810-985-5600",
            "fax_number": "810-985-5740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILLIP A. KOHANOV O.D. PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-15",
        "last_updated": "2012-06-05",
        "status": "A",
        "authorized_official_last_name": "KOHANOV",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "810-985-5600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "900G465140",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGION B DMERC",
            "identifier": "1038350001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jerrie Michele Pemberton, OTR
• Amanda Michelle Penley
• Marie Peterson, OD
• Jennifer Ann Peyerk, P.T.
• Katherine Ann Phelan, M.A., CCC-SLP
• Physician Healthcare Network, PC
• Bailey Piacentini
• Katherine Bernadette Pizzo
• Placed on Purpose
• Randy John Plonka, MD

• Optometrist in Fort Gratiot, MI
• Providers in Fort Gratiot, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2012; 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.