MID MICHIGAN EYE CARE CENTER, PC (NPI# 1649275041) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649275041 |
| Entity Type | Organization |
| Organization Name | MID MICHIGAN EYE CARE CENTER, PC |
| Other Organization Name | SPECIALTY EYE INSTITUTE |
| Practice Address |
1116 W. Ganson Street Jackson MI 49202-4240 |
| Mailing Address |
850 W. North Street Ste. 104 Jackson MI 49202-3196 |
| Practice Telephone | 8778528463 |
| Practice Fax Number | 5178170144 |
| Mailing Telephone | 8778528463 |
| Mailing Fax Number | 5178170144 |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2018-11-26 |
| Authorized Official Name | MR. THOMAS T ROARK (CEO) |
| Authorized Official Telephone | 5178413007 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 152W00000X | Optometrist | Eye and Vision Services Providers | ||
| N | 207W00000X | Ophthalmology | 4301034151 | MI | Allopathic & Osteopathic Physicians |
| N | 207WX0107X |
Ophthalmology Specialization: Retina Specialist |
Allopathic & Osteopathic Physicians | ||
| Y | 207W00000X | Ophthalmology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | RAILROAD MEDICARE | CC5220 | 01 |
| MI | BCBSM | 180C846310 | 01 |
| MI | RAILROAD MEDICARE | C31544 | 01 |
| MI | BCBSM | 900N834800 | 01 |
| MI | BCBSM | 180H149970 | 01 |
| MI | BCBSM | 900C848370 | 01 |
| BCBSM | 900H115380 | 01 |
| Other Name | Type Code |
|---|---|
| Specialty Eye Institute | Doing Business As Name - Organization |
| Street Address |
1116 W. GANSON STREET |
| City | JACKSON |
| State | MI |
| Zip Code | 49202-4240 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821590316 | Leslie Dominique Barroso | Social Worker | 834 Kennedy St, Jackson, MI 49202 | 2018-03-01 |
| 1073011136 | Nicole Szarek | Social Worker | 1200 N. West Ave, Jackson, MI 49202 | 2018-01-24 |
| 1598299430 | Cedric Griffin | Behavior Technician | 950 W. Monroe St, Jackson, MI 49202 | 2017-04-18 |
| 1285081612 | Patricia Decker | Psychologist | 950 West Monroe, Suite 500, Jackson, MI 49202 | 2016-05-16 |
| 1619344314 | Erica Ries | Social Worker | 1200 N West Ave Ste 800, Jackson, MI 49202 | 2015-08-28 |
| 1184007189 | Sarah Johnson | Behavioral Analyst | 818 Winifred St, Jackson, MI 49202 | 2015-07-08 |
| 1871971697 | Scott A Watterson Dds, Pllc | Dentist | 1030 Laurence Ave, Suite 3, Jackson, MI 49202 | 2015-05-13 |
| 1043608680 | Brenda Beverly | Counselor | 1190 West, 1190 West Suite 812, Jackson, MI 49202 | 2015-01-06 |
| 1295091593 | Natalie Ann Kember | Social Worker | 1206 Clinton, Jackson, MI 49202 | 2012-04-11 |
| 1912218728 | Tina Marie Pierce | Respite Care | 225 N Wisner St, Jakson, MI 49202 | 2010-06-25 |
| Find all providers in zip 49202 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639532468 | Lee Finley Jones | Ophthalmology | 1501 Lakeland Dr Ste 100, Jackson, MS 39216-4869 | 2016-03-30 |
| 1861777161 | Parkside Eye Clinic P.C. | Ophthalmology | 2108 Fourth Street, Jackson, MI 49203-4518 | 2011-10-18 |
| 1043514607 | Jeevak Lal | Ophthalmology | 5887 N Rickfield Rd, Jackson, MI 49201-8314 | 2010-12-22 |
| 1447568241 | Laura L Dipuma | Ophthalmology | 2027 Greystone Sq, Jackson, TN 38305-3576 | 2010-09-15 |
| 1477879062 | James Arnold Luebbers | Ophthalmology | 687 East Kelly Ave., Bx 3797, Jackson, WY 83001-3797 | 2010-04-08 |
| 1366624801 | Premier Eye Care, Pllc | Ophthalmology | 30 Howell Ln, Jackson, KY 41339-8657 | 2007-11-27 |
| 1932224748 | Eyecare Professionals Pa | Ophthalmology | 1501 Lakeland Drive, Suite 100, Jackson, MS 39216-4848 | 2007-03-20 |
| 1053410126 | Ophthalmic Plastic Surgery Specialists Pllc | Ophthalmology | 1421 North State St, Ste 304, Jackson, MS 39202 | 2006-09-22 |
| 1114020906 | James Alvin Bruce Jr. | Ophthalmology | 2500 Lakeland Dr, Ste A, Jackson, MS 39232 | 2006-09-06 |
| 1639272693 | Charles Gerard Sherwood | Ophthalmology | 1500 Woodrow Wilson Ave, G. V. 'sonny' Montgomery Va Medical Center, Jackson, MS 39216 | 2006-09-06 |
| Find all providers in JACKSON | ||||
Please comment or provide details below to improve the information on MID MICHIGAN EYE CARE CENTER, PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.