Individual provider Active NPI

Michael E. Millsap, O.D.

  • Optometrist
  • Salida, CO
National Provider Identifier
1841440690
Registry record updated Jan 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1365 Issued in CO
Practice address
515 E 1St St
Salida, CO 81201-2805
Phone
(719) 539-3581
Fax
(719) 539-4992
NPI assigned
Sep 29, 2008
Last updated
Jan 20, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 20, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1365 CO Primary

Addresses

Primary practice location

515 E 1St St
Salida, CO 81201-2805

Mailing address

27 Montebello Rd
Pueblo, CO 81001-1236
Phone (719) 545-1530

Other identifiers 2

IdentifierTypeStateIssuer
08013658MedicaidCO
COA104412OtherCOMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20091028000080 CO Practitioner - Optometry 2860539665 Reassigns benefits to 1 organization
I20241016000907 WA Practitioner - Optometry 2860539665 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Melissa Barnhart OD PLLCGroup PAC ID 4880828466, 5 clinicians

Practice addresses (Care Compare)

12 E Rowan Ave
Suite 1
Spokane, WA 99207-1281
Phone (509) 487-0600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1365COMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Rocky Mountain Eye Center Inc a Colorado Provider Network Optometrist Current Accepting new patients
Melissa Barnhart, OD, PLLC Optometrist CurrentSince Oct 1, 2024 Accepting new patients
James C Wavra Optometrist PastSince Oct 1, 2024 Accepting new patients

Locations

27 Montebello Rd
Pueblo, CO 81001
Phone (719) 545-1530

12 E Rowan Ave
Ste 1
Spokane, WA 99207
Phone (509) 466-2643

12121 E Broadway Ave
Ste 1
Spokane Valley, WA 99206
Phone (509) 928-1212

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1222646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453248000000",
    "number": "1841440690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 MONTEBELLO RD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810011236",
            "telephone_number": "719-545-1530",
            "fax_number": "719-545-2899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 E 1ST ST",
            "city": "SALIDA",
            "state": "CO",
            "postal_code": "812012805",
            "telephone_number": "719-539-3581",
            "fax_number": "719-539-4992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLSAP",
        "first_name": "MICHAEL",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-29",
        "last_updated": "2016-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "1365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08013658",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "COA104412",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salida, CO

Sources for this page

Verify at the official NPI Registry.