Organization Active NPI

Advanced Family Eye Care, PC

  • Optometrist
  • Saint Joseph, MI
National Provider Identifier
1912958919
Registry record updated Feb 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901003732 Issued in MI
Legal business name
ADVANCED FAMILY EYE CARE, PC
Practice address
2810 Niles Rd
Saint Joseph, MI 49085-3338
Phone
(269) 429-6781
Fax
(269) 429-5006
NPI assigned
May 14, 2006
Last updated
Feb 4, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2009

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

Authorized official

Name
Dr. Jeffrey Scieszka, O.D.NPI 1316160252
Title
Owner
Phone
(269) 429-6781

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901003732 MI Primary

Addresses

Primary practice location

2810 Niles Rd
Saint Joseph, MI 49085-3338

Mailing address

2810 Niles Rd
Saint Joseph, MI 49085-3338
Phone (269) 429-6781

Other identifiers 1

IdentifierTypeStateIssuer
4627201MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050113000706 MI Part B Supplier - Clinic/Group Practice 4688623911 Receives reassigned benefits from 3 practitioners
Practice locations: Saint Joseph, MI

National Provider Directory

National Provider Directory

Locations

222 State St
Saint Joseph, MI 49085
Phone (269) 982-4237

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1147564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233705600000",
    "number": "1912958919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 NILES RD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853338",
            "telephone_number": "269-429-6781",
            "fax_number": "269-429-5006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 NILES RD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853338",
            "telephone_number": "269-429-6781",
            "fax_number": "269-429-5006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED FAMILY EYE CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-14",
        "last_updated": "2009-02-04",
        "status": "A",
        "authorized_official_last_name": "SCIESZKA",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-429-6781",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003732",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4627201",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2009; 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.