Justin Champion Ullrey, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901005240 Issued in MI

Practice address

25 N Main St
Rockford, MI 49341-1281

Phone

(616) 866-3077

NPI assigned

Jun 5, 2019

Last updated

Jun 5, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Locations

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.

• Family & Pediatric Eye Care PLC

  • Pediatric Optometrist
  • Grand Rapids, MI
  • NPI 1417137084
  Medicare reassignment NPD
• Rockford Vision Services, Inc.

  • Prosthetic/Orthotic Supplier
  • Rockford, MI
  • NPI 1760680144
  NPD (past)

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

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559692800000",
    "number": "1982263711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10502 SHANER AVE NE",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493418461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 N MAIN ST",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493411281",
            "telephone_number": "616-866-3077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ULLREY",
        "first_name": "JUSTIN",
        "middle_name": "CHAMPION",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-05",
        "last_updated": "2019-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901005240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooke Treadwell
• James Frederick Trewhella, QMRP
• Trinity Health-Michigan (Mercy Health Pharmacy - Rockford)
• Trufant Chiropractic Center, LLC (Cultivate Health Chiropractic)
• Katie Anne Trusty, BT
• Olivia Van Der Maas, BT
• Kelly Van Kampen, ATC
• Diane Marie Vancamp
• Sara Lynn Vance, LMSW
• Linda Marie Vandenbosch, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2019; 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.