Active NPI
Myeyedr Optometry of Michigan, LLC
Doing business as RX Optical
- Optometrist
- Kentwood, MI
National Provider Identifier
1871172858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- Legal business name
- MYEYEDR OPTOMETRY OF MICHIGAN, LLC
- Doing business as
- RX Optical
- Practice address
- 2350 44TH St SE
Kentwood, MI 49508-5016 - Phone
- (616) 281-1011
- Fax
- (616) 281-4941
- NPI assigned
- Apr 6, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Sue Downes
- Title
- Secretary
- Phone
- (703) 847-8899
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | Primary |
Addresses
Primary practice location
2350 44TH St SE
Kentwood, MI 49508-5016
Mailing address
8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899
Other names 1
- RX Optical
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191014002048 | MI | Part B Supplier - Clinic/Group Practice | 7416288949 |
Receives reassigned benefits from 139 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Tax ID family
- Myeyedr Optometry Mi LLC
Other organizations with this tax ID 47
Organizations that report the same tax identification number in the National Provider Directory.
-
- Optometrist
- Van Buren TWP, MI
- NPI 1225619760
Locations
2350 44th St SE
Kentwood, MI 49508
Phone (616) 281-1011
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617667200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1653609600000",
"number": "1871172858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8614 WESTWOOD CENTER DR FL 9",
"city": "VIENNA",
"state": "VA",
"postal_code": "221822442",
"telephone_number": "703-847-8899",
"fax_number": "571-223-6780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2350 44TH ST SE",
"city": "KENTWOOD",
"state": "MI",
"postal_code": "495085016",
"telephone_number": "616-281-1011",
"fax_number": "616-281-4941"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MYEYEDR OPTOMETRY OF MICHIGAN, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-04-06",
"last_updated": "2022-05-27",
"certification_date": "2022-05-27",
"status": "A",
"authorized_official_last_name": "DOWNES",
"authorized_official_first_name": "SUE",
"authorized_official_title_or_position": "SECRETARY",
"authorized_official_telephone_number": "703-847-8899"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "RX Optical",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "RX Optical",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Kentwood, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2022; 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.