BRENT OPTICAL (NPI# 1396715199) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396715199 |
| Entity Type | Organization |
| Organization Name | BRENT OPTICAL |
| Other Organization Name | JOHNSTON OPTICAL COMPANY |
| Practice Address |
25 Michigan St Ne Suite 1000 Grand Rapids MI 49503-2561 |
| Practice Telephone | 6164581951 |
| Practice Fax Number | 6164582089 |
| Mailing Telephone | 6164581951 |
| Mailing Fax Number | 6164582089 |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2009-03-30 |
| Authorized Official Name | MR. BRENT W. BALKEMA (OWNER) |
| Authorized Official Telephone | 6164581951 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 156FX1800X |
Technician/Technologist Specialization: Optician |
Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBSM | 0D16535 | 01 |
| MI | 943136666 | 05 |
| Other Name | Type Code |
|---|---|
| Johnston Optical Company | Doing Business As Name - Organization |
| Street Address |
25 MICHIGAN ST NE SUITE 1000 |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49503-2561 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639175342 | Stephen Christopher Cook | Pediatrics | 25 Michigan St Ne, Suite 4300, Grand Rapids, MI 49503 | 2005-06-27 |
| 1407412539 | Aneta Toma | Student in an Organized Health Care Education/Training Program | 25 Michigan St Ne, Grand Rapids, MI 49503-2515 | 2019-05-14 |
| 1033673363 | Kara Vanderkallen | Student in an Organized Health Care Education/Training Program | 25 Michigan St Ne, Grand Rapids, MI 49503-2515 | 2019-01-31 |
| 1902391964 | Carmen Kagha | Family Medicine | 25 Michigan St Ne, Grand Rapids, MI 49503-2515 | 2018-06-22 |
| 1700394301 | Daniel Jacob Elliott | Student in an Organized Health Care Education/Training Program | 25 Michigan St Ne, Grand Rapids, MI 49503-2515 | 2018-01-17 |
| 1629585997 | Dylan Lee Kosaski | Student in an Organized Health Care Education/Training Program | 25 Michigan St Ne, Grand Rapids, MI 49503-2515 | 2018-01-08 |
| 1073020343 | Rachel Pavona | Pharmacy Technician | 25 Michigan St Ne, Grand Rapids, MI 49503-2515 | 2018-01-08 |
| 1154842193 | Asaf Harris | Internal Medicine | 25 Michigan St Ne, Suite 2100, Grand Rapids, MI 49503-2526 | 2017-06-29 |
| 1811439763 | Danielle Susan Douglass | Physician Assistant | 25 Michigan St Ne, Suite 6100, Grand Rapids, MI 49503-2515 | 2016-11-09 |
| 1457803751 | Anina L Cicerone-carder | Physician Assistant | 25 Michigan St Ne, Suite 6100, Grand Rapids, MI 49503-2515 | 2016-11-03 |
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|---|---|---|---|---|
| 1801496195 | Airway Oxygen, Inc. | Durable Medical Equipment & Medical Supplies | Lemmen Holton Cancer Pavilion, 145 Michigan St Ne Ste 3400, Grand Rapids, MI 49503 | 2020-10-27 |
| 1730707282 | Adriana Molina-schmuker | Counselor | 901 Eastern Avenue Ne, Grand Rapids, MI 49503 | 2020-07-10 |
| 1477176949 | Kimberly Buskirk | Specialist | 1131 Ionia Ava Nw, Grand Rapids, MI 49503 | 2020-05-19 |
| 1124647805 | Jared Host | Speech-Language Pathologist | Mercy Health Hauenstein Neuroscience Center 220 Cherry, Grand Rapids, MI 49503 | 2020-04-13 |
| 1265061378 | Heather Gladfelter | Student in an Organized Health Care Education/Training Program | 339 Barclay Ave Ne Ste 300, Grand Rapids, MI 49503 | 2020-04-02 |
| 1194368647 | Amy Jo Arends | Nurse Practitioner | 350 Lafayette S.e., Suite 301, Grand Rapids, MI 49503 | 2019-10-28 |
| 1376185199 | Beth Arce | Occupational Therapist | 245 Cherry St Se Suite 302, Grand Rapids, MI 49503 | 2019-10-14 |
| 1295387256 | Althea Ziolkowski | Licensed Practical Nurse | Salvation Army Turning Point Programs, 1215 Fulton St E, Grand Rapids, MI 49503 | 2019-07-10 |
| 1790340719 | Heather Anne Fox | Occupational Therapist | Marywood, 111 Lakeside Dr Ne, Grand Rapids, MI 49503 | 2019-05-06 |
| 1184182883 | April L Kaiserlian | Social Worker | 983 Spaulding Ave Ne, Ada, MI 49503 | 2019-03-12 |
| Find all providers in zip 49503 | ||||
| Taxonomy Code | 156FX1800X |
| Grouping | Eye and Vision Services Providers |
| Classification | Technician/Technologist |
| Specialization | Optician |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689110710 | W. Optical 2 LLC | Technician/Technologist | 3233 Alpine Ave Nw Ste A, Grand Rapids, MI 49544-1631 | 2017-01-12 |
| 1225276991 | America's Best Contacts & Eyeglasses | Technician/Technologist | 1971 E Beltline Ave Ne Ste 127, Grand Rapids, MI 49525-7058 | 2009-02-03 |
| 1689202848 | W Optical Services LLC | Technician/Technologist | 3233 Alpine Ave Nw Ste A, Grand Rapids, MI 49544-1631 | 2020-03-31 |
| 1205497443 | Maria Fernanda Winters | Technician/Technologist | 3233 Alpine Ave Nw Ste A, Grand Rapids, MI 49544-1631 | 2019-06-27 |
| 1114165214 | Judy Essenberg | Technician/Technologist | 4069 Lake Dr Se, Suite 315, Grand Rapids, MI 49546-8816 | 2009-01-27 |
| 1124168232 | Douglas E Cramer | Technician/Technologist | 511 Wilson Ave Nw, Suite G, Grand Rapids, MI 49534-7986 | 2007-02-07 |
| 1003992249 | Wal-mart Stores East, Lp | Technician/Technologist | 5859 28th St Se, Grand Rapids, MI 49546-6905 | 2006-10-31 |
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|---|---|---|---|---|
| 1588201420 | William Wise | Technician/Technologist | 410 North St, Otisville, MI 48463-9705 | 2019-12-10 |
| 1033750658 | American Eye Institute Optical Inc | Technician/Technologist | 2300 Haggerty Rd Ste 1100, West Bloomfield, MI 48323-2185 | 2019-10-04 |
| 1225595705 | National Vision Inc | Technician/Technologist | 1328 S Rochester Rd, Rochester Hills, MI 48307-3124 | 2019-02-21 |
| 1184191306 | National Vision Inc | Technician/Technologist | 50697 Waterside Dr, Chesterfield, MI 48051-4008 | 2018-10-25 |
| 1275045916 | W. Optical 4 LLC | Technician/Technologist | 1004 28th St Sw, Wyoming, MI 49509-2881 | 2017-11-03 |
| 1164932489 | Salim Rufo Auraha | Technician/Technologist | 3747 15 Mile Rd, Sterling Heights, MI 48310-5358 | 2017-10-02 |
| 1720527955 | Wal-mart Stores East, Lp | Technician/Technologist | 2755 W Holton-whitehall Rd, Whitehall, MI 49461 | 2017-02-21 |
| 1811434293 | Joseph Frye-dandridge | Technician/Technologist | 18669 Oakfield St, Detroit, MI 48235-3060 | 2017-01-24 |
| 1811377740 | Kat Stannis LLC | Technician/Technologist | 1794 N Old Us 23, Howell, MI 48843-7193 | 2015-06-05 |
| 1124411491 | W Optical 3 LLC | Technician/Technologist | 31503 Gratiot Ave, Roseville, MI 48066-4583 | 2015-03-11 |
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| City | GRAND RAPIDS |
| Zip Code | 49503 |
Please comment or provide details below to improve the information on BRENT OPTICAL.
| 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.