Davison Vision Center LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901003314 Issued in MI

Legal business name

DAVISON VISION CENTER LLC

Practice address

1097 S State Rd
Ste 1
Davison, MI 48423-1934

Phone

(810) 653-4800

Fax

(810) 412-4124

NPI assigned

Feb 13, 2007

Last updated

Sep 28, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Coriasso, O.DNPI 1366584674

Title

Owner

Phone

(810) 653-4800

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 1

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.

• David M Coriasso, O.D.

  • Optometrist
  • Davison, MI
  • NPI 1366584674
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475020800000",
    "number": "1952443293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1097 S STATE RD",
            "address_2": "STE 1",
            "city": "DAVISON",
            "state": "MI",
            "postal_code": "484231934",
            "telephone_number": "810-653-4800",
            "fax_number": "810-412-4124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1097 S STATE RD",
            "address_2": "STE 1",
            "city": "DAVISON",
            "state": "MI",
            "postal_code": "484231934",
            "telephone_number": "810-653-4800",
            "fax_number": "810-412-4124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVISON VISION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2016-09-28",
        "status": "A",
        "authorized_official_last_name": "CORIASSO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-653-4800",
        "authorized_official_credential": "O.D"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "900B51565",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Scott Delange, DPT
• Julie Derby
• Erin Renee Desgrange, COTA-L
• Destiny Enterprises
• Deanna Devlaminck, SLP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.