Traverse City Eye Consultants P C

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

TRAVERSE CITY EYE CONSULTANTS P C

Practice address

419 S Coral St
Kalkaska, MI 49646-2500

Phone

(231) 935-8101

Fax

(231) 935-0955

NPI assigned

Dec 15, 2006

Last updated

Mar 30, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

TRAVERSE CITY EYE CONSULTANTS P CAs reported in NPPES

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

Authorized official

Name

Kenneth B Gum, M.D.

Title

Doctor

Phone

(231) 935-8101

Specialties & licenses 2

Addresses

Other identifiers 2

Part of

Traverse City Eye Consultants PC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Traverse City Eye Consultants P C

  • Ophthalmology Physician
  • Traverse City, MI
  • NPI 1316009368
  NPPES parent name

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617062400000",
    "number": "1861554636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5199 N ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496849201",
            "telephone_number": "231-935-8101",
            "fax_number": "231-935-0955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 S CORAL ST",
            "city": "KALKASKA",
            "state": "MI",
            "postal_code": "496462500",
            "telephone_number": "231-935-8101",
            "fax_number": "231-935-0955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRAVERSE CITY EYE CONSULTANTS P C",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRAVERSE CITY EYE CONSULTANTS P C",
        "enumeration_date": "2006-12-15",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A",
        "authorized_official_last_name": "GUM",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "231-935-8101",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0N89560",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0N89570",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carrilyn Florence Stobert, DDS
• Roger Troy Stobert, DDS
• Holly Jo Swinehart, OTR/L
• Aaron David Swoverland, DPT
• Townline Family PC (Kalkaska Family Vision Care)
• Timothy John Troupe, OD
• David K Vandekieft, PA-C
• Kara Emery Vanderwoude
• Village Chiropractic Wellness Center, PLC
• Erin Bridget Vorgias, MSW INTERN

• Ophthalmology Physician in Kalkaska, MI
• Providers in Kalkaska, MI by specialty
• Ophthalmology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; 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.