NPIMap

Organization Active NPI

Stadium Opticians, Inc.

  • Optician
  • Ann Arbor, MI
National Provider Identifier
1851443766
Registry record updated May 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
Legal business name
STADIUM OPTICIANS, INC.
Practice address
2333 W Stadium Blvd
Ann Arbor, MI 48103-3844
Phone
(734) 663-0870
Fax
(734) 761-5242
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2008

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

Authorized official

Name
Mr. Charles R. Meldrum, OPTICIAN
Title
Pres.
Phone
(734) 663-0870

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193400000X SINGLE SPECIALTY GROUP 156FX1800X Primary

Addresses

Primary practice location

2333 W Stadium Blvd
Ann Arbor, MI 48103-3844

Mailing address

2333 W Stadium Blvd
Ann Arbor, MI 48103-3844
Phone (734) 663-0870

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930025458 MI DME Supplier - Physician - OptometristDME Supplier - Optician 6103815204 Practice locations: Ann Arbor, MI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Stadium Opticians Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2333 W Stadium Blvd
Ann Arbor, MI 48103

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211846400000",
    "number": "1851443766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2333 W STADIUM BLVD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481033844",
            "telephone_number": "734-663-0870",
            "fax_number": "734-761-5242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2333 W STADIUM BLVD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481033844",
            "telephone_number": "734-663-0870",
            "fax_number": "734-761-5242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STADIUM OPTICIANS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2008-05-27",
        "status": "A",
        "authorized_official_last_name": "MELDRUM",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRES.",
        "authorized_official_telephone_number": "734-663-0870",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OPTICIAN"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; 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.