NPIMap

Organization Active NPI

C & C Optical Shop Inc.

  • Eyewear Supplier
  • Fremont, MI
National Provider Identifier
1992811632
Registry record updated Jan 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
1262670001 Issued in MI
Legal business name
C & C OPTICAL SHOP INC.
Practice address
1007 W Main St
Fremont, MI 49412-1420
Phone
(231) 924-1988
Fax
(231) 924-1622
NPI assigned
Aug 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2008

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

Authorized official

Name
Mrs. Cherry Marie Walton
Title
Manager
Phone
(231) 924-1988

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X 1262670001 MI Primary

Addresses

Primary practice location

1007 W Main St
Fremont, MI 49412-1420

Mailing address

1007 W Main St
Fremont, MI 49412-1420
Phone (231) 924-1988

Other identifiers 1

IdentifierTypeStateIssuer
3455345MedicaidMI

National Provider Directory

National Provider Directory

Locations

1007 W Main St
Fremont, MI 49412
Phone (231) 924-1988

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199923200000",
    "number": "1992811632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 W MAIN ST",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "494121420",
            "telephone_number": "231-924-1988",
            "fax_number": "231-924-1622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 W MAIN ST",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "494121420",
            "telephone_number": "231-924-1988",
            "fax_number": "231-924-1622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C & C OPTICAL SHOP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2008-01-10",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "CHERRY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "231-924-1988",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MI",
            "license": "1262670001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3455345",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.