Stacy L Davis, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901003961 Issued in MI

Practice address

6739 Fulton St E
Ste a-20
Ada, MI 49301-8138

Phone

(616) 676-2015

Fax

(616) 676-2011

NPI assigned

Oct 4, 2006

Last updated

Nov 29, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Von Scott Hieneman, O.D.

  • Optometrist
  • Ada, MI
  • NPI 1760540363
  Medicare reassignment
• Ada Vision Center PLLC

  • Optometrist
  • Ada, MI
  • NPI 1467479212
  NPD (past)

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290988800000",
    "number": "1891880548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6739 FULTON ST E",
            "address_2": "STE A-20",
            "city": "ADA",
            "state": "MI",
            "postal_code": "493018138",
            "telephone_number": "616-676-2015",
            "fax_number": "616-676-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6739 FULTON ST E",
            "address_2": "STE A-20",
            "city": "ADA",
            "state": "MI",
            "postal_code": "493018138",
            "telephone_number": "616-676-2015",
            "fax_number": "616-676-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "STACY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2010-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Jandernoa Cramer, PHD, L.P.
• Ethan Brent Cunningham, FNP-C
• Conor Dahlquist
• Daniel K. Ehnis, PC
• Kristen Daniels, LMSW
• Dawn Jenkins LMSW
• Brittani Decess, MA, LLPC
• Michelle Lynn Degraaf, MSN, ANP, BC
• Kaitlin M Delehanty, MA
• Mariah Depoy

• Optometrist in Ada, MI
• Providers in Ada, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.