SMALL MALL VISION CENTER (NPI# 1861513780) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861513780 |
| Entity Type | Organization |
| Organization Name | SMALL MALL VISION CENTER |
| Practice Address |
3600 S Dort Hwy Flint MI 48507-2093 |
| Practice Telephone | 8107432830 |
| Practice Fax Number | 8107431729 |
| Mailing Telephone | 8107432830 |
| Mailing Fax Number | 8107431729 |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | JULIE LANDIS (BILLER) |
| Authorized Official Telephone | 8107432830 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBS OF MI | 0B565030 | 01 |
| Street Address |
3600 S DORT HWY |
| City | FLINT |
| State | MI |
| Zip Code | 48507-2093 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881680304 | Susan M. Wedda | Social Worker | 3600 S Dort Hwy, Suite 44, Flint, MI 48507-2093 | 2005-09-20 |
| 1023444148 | Michele Annette Walker | Social Worker | 3600 S Dort Hwy, Suite 54, Flint, MI 48507-2093 | 2013-09-20 |
| 1346590858 | Pamela July | Social Worker | 3600 S Dort Hwy, Flint, MI 48507-2093 | 2012-09-12 |
| 1194966705 | Landis Vision Center LLC | Technician/Technologist | 3600 S Dort Hwy, Flint, MI 48507-2093 | 2009-03-11 |
| 1720239700 | The Disability Network | Supports Brokerage | 3600 S Dort Hwy, Suite 54, Flint, MI 48507-2093 | 2008-10-08 |
| 1134344773 | Nancy Kaye Kreger Aills | Social Worker | 3600 S Dort Hwy, Suite 44, Flint, MI 48507 | 2007-04-17 |
| 1578697744 | Sara Suzanne Griffin | Counselor | 3600 S Dort Hwy, Suite 44, Flint, MI 48507-2093 | 2007-03-16 |
| 1982706537 | Tamala Kay Dickey | Counselor | 3600 S Dort Hwy, Suite 46, Flint, MI 48507 | 2006-09-03 |
| 1023110673 | Susan D Markle | Social Worker | 3600 S Dort Hwy, Ste 46, Flint, MI 48507 | 2006-09-03 |
| 1134175607 | Auburn Counseling Associates, Inc. | Clinic/Center | 3600 S Dort Hwy, Suite 44, Flint, MI 48507-2093 | 2006-05-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245847870 | Alexis Nichole Leach | Physician Assistant | 5494 South Dort Hwy, Flint, MI 48507 | 2020-09-28 |
| 1508330317 | Jeffrey Mark Funck | Registered Nurse | G-4443 Miller Road, Suite 100, Flint, MI 48507 | 2019-01-15 |
| 1861981292 | Lavonne L Alexander | Nurse Practitioner | 4500 S Saginaw St Ste 1875, Flint, MI 48507 | 2018-05-01 |
| 1760984348 | Melissa Dawn Hoffman | Psychologist | 5402 Gateway Centre Drive, Suite B, Flint, MI 48507 | 2018-02-28 |
| 1902327323 | Katee Mast | Case Manager/Care Coordinator | 110 Eldon Baker Drive, Flint, MI 48507 | 2017-07-06 |
| 1699228460 | Joshua Sinclair | Social Worker | 2442 E Maple Ave Ste 207, Flint, MI 48507 | 2016-07-28 |
| 1477903730 | Gracie Hunter | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1110 Eldon Baker, Flint, MI 48507 | 2016-06-17 |
| 1528412822 | Drita Gojcaj | Massage Therapist | 3426 Miller Road, Flint, MI 48507 | 2016-04-22 |
| 1629422100 | Ellen Makarewicz-ely | Massage Therapist | 3426 Miller Rd, Flint, MI 48507 | 2016-04-20 |
| 1700262722 | Katelyn Bailey | Nurse Practitioner | 1420 W Twelfth St, Flint, MI 48507 | 2015-07-31 |
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| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053926089 | Estefany Colon Lopez | Optometrist | 3497 S Linden Rd Spc 780, Flint, MI 48507-3018 | 2020-09-15 |
| 1750935326 | St. Luke N.e.w. Life Center, Inc. | Optometrist | 3115 Lawndale Ave., Flint, MI 48504 | 2019-07-31 |
| 1447542485 | Goodwill Optical Inc | Optometrist | 4340 Miller Rd, Suite A, Flint, MI 48507-1297 | 2011-05-10 |
| 1194867416 | Kate Hentes | Optometrist | 3497 S Linden Rd, Flint, MI 48507-3018 | 2007-02-13 |
| 1356497432 | Jeffery M Iceberg | Optometrist | 3192 S Linden Rd, Suite B121, Flint, MI 48507 | 2007-01-25 |
| 1275682015 | Jennifer Lynn Smalley-huber | Optometrist | 3377 S Linden Rd, Flint, MI 48507-3007 | 2007-01-10 |
| 1487714648 | Josephus Knight Jr. | Optometrist | 4487 Miller Rd, Flint, MI 48507-1126 | 2006-12-11 |
| 1881754893 | Flint Sensory Learning Center LLC | Optometrist | 4091 Richfield Rd, Flint, MI 48506-2033 | 2006-12-11 |
| 1508876814 | Lee H Halsted | Optometrist | 3405 S Linden Rd, Flint, MI 48507-3009 | 2006-08-09 |
| 1669482394 | Chris Hall | Optometrist | G3548 Flushing Rd, Flint, MI 48504-4255 | 2006-08-08 |
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| 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.