Christopher David Theodoroff, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901003333 Issued in MI

Practice address

28825 Ryan Rd
Warren, MI 48092-4128

Phone

(586) 573-0470

Fax

(586) 573-0648

NPI assigned

Aug 2, 2006

Last updated

Jul 10, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 5

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

Specialty

Optometry

Education

Ferris State College - College of Optometry, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northwest Eye Physicians, P.C.Group PAC ID 1951295427, 5 clinicians

Practice addresses (Care Compare)

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.

• Northwest Eye Physicians, P.C.

  • Ophthalmology Physician
  • Southfield, MI
  • NPI 1740244037

  Optometrist

  Medicare reassignment Care Compare group NPD
• Professional Family Eyecare Inc.

  • Optometrist
  • Warren, MI
  • NPI 1295896900
  Authorized official Same address or phone
• Northwest Eye Physicians, P.C.

  • Eyewear Supplier
  • Novi, MI
  • NPI 1306269436

  Optometrist

  NPD
• Eye Care Providers of Michigan PC

  dba Eye Care Center of Port Huron

  • Ophthalmology Physician
  • Port Huron, MI
  • NPI 1134254071
  NPD (past)

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215648000000",
    "number": "1982611745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61656 SPRING CIRCLE TRL",
            "city": "WASHINGTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480941143",
            "telephone_number": "248-656-3292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28825 RYAN RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480924128",
            "telephone_number": "586-573-0470",
            "fax_number": "586-573-0648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEODOROFF",
        "first_name": "CHRISTOPHER",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2008-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2674552",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5189678",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NSC",
            "identifier": "1314720001",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "900E066750",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5189669",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2008; 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.
• 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.