CEDAR RUN EYE CENTER, PLLC (NPI# 1518029909) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518029909 |
| Entity Type | Organization |
| Organization Name | CEDAR RUN EYE CENTER, PLLC |
| Practice Address |
3830 W Front St Traverse City MI 49684-8153 |
| Practice Telephone | 2319293888 |
| Practice Fax Number | 2319294365 |
| Mailing Telephone | 2319293888 |
| Mailing Fax Number | 2319294365 |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2015-05-11 |
| Authorized Official Name | DR. TIMOTHY B. HANLEY (OWNER) |
| Authorized Official Telephone | 2319293888 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | 4301048021 | MI | Suppliers |
| N | 152W00000X | Optometrist | 4901003094 | MI | Eye and Vision Services Providers |
| N | 152W00000X | Optometrist | 4901003086 | MI | Eye and Vision Services Providers |
| N | 152W00000X | Optometrist | 4901004107 | MI | Eye and Vision Services Providers |
| Y | 207W00000X | Ophthalmology | 4301048021 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | PRIORITY - CREC | 900001413 | 01 |
| MI | BCBS TBH | 180B86357 | 01 |
| MI | RAILROAD MEDICARE/HANLEY | 1144214180 | 01 |
| MI | RAILROAD MEDICARE/HUMMEL | 1497736102 | 01 |
| MI | RAILROAD MEDICARE/TSC | CG1308 | 01 |
| MI | DMERC REGION B | 1020070001 | 01 |
| MI | RAILROAD MEDICARE/CIZEK | 1134113517 | 01 |
| MI | 943166469 | 05 | |
| MI | 943166487 | 05 | |
| MI | PREFERRED CHOICE | 102022 | 01 |
| MI | 103164508 | 05 | |
| MI | BCBS OPTOM GROUP | 900B86347 | 01 |
| MI | RAILROAD MEDICARE/CREC | CN1586 | 01 |
| MI | BCBSM | 900B86347001 | 01 |
| MI | 943166496 | 05 | |
| MI | BCBSM | 900B86347003 | 01 |
| Street Address |
3830 W FRONT ST |
| City | TRAVERSE CITY |
| State | MI |
| Zip Code | 49684-8153 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851383129 | Bradley S Hochstetler | Ophthalmology | 3830 W Front St, Traverse City, MI 49684-8153 | 2005-08-22 |
| 1366651572 | Robert F Stevenson | Ophthalmology | 3830 W Front St, Traverse City, MI 49684-8153 | 2007-05-22 |
| 1265653224 | Cedar Run Eye Center | Optometrist | 3830 W Front St, Traverse City, MI 49684-8153 | 2007-05-01 |
| 1215157367 | Cedar Run Eye Center Optical | Optometrist | 3830 W Front St, Traverse City, MI 49684-8153 | 2007-04-30 |
| 1942420096 | Cedar Run Eye Center-beulah Optical | Eyewear Supplier (Equipment, not the service) | 3830 W Front St, Traverse City, MI 49684-8153 | 2007-04-30 |
| 1134235252 | Linda Jean Madigan | Nurse Anesthetist, Certified Registered | 3830 W Front St, Traverse City, MI 49684-8153 | 2006-08-22 |
| 1497736102 | Jodi Marie Hummel | Optometrist | 3830 W Front St, Traverse City, MI 49684-8153 | 2005-11-09 |
| 1144214180 | Timothy B. Hanley | Ophthalmology | 3830 W Front St, Traverse City, MI 49684-8153 | 2005-09-06 |
| 1134113517 | Kathryn A Cizek | Optometrist | 3830 W Front St, Cedar Run Eye Center, Traverse City, MI 49684-8153 | 2005-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124641758 | Karen Anne Paulosky | Registered Nurse | 226 S Madison St, Traverse City, MI 49684 | 2020-05-18 |
| 1891314795 | Jaclyn Elizabeth Sylvain | Student in an Organized Health Care Education/Training Program | Munson Family Practice Center, 1400 Medical Campus Drive, Traverse City, MI 49684 | 2020-04-10 |
| 1285282988 | Madelyn Drumm | Dietitian, Registered | 217 S. Madison St., Suite 3022, Traverse City, MI 49684 | 2019-08-27 |
| 1265917686 | Kacie Danielle Heading | Social Worker | 12719 S. West Bay Shore Drive, Suite 9, Traverse City, MI 49684 | 2018-10-02 |
| 1881178325 | Jacob White Ph.d., Pllc | Psychologist | 3537 W. Front Street, Suite F, Traverse City, MI 49684 | 2018-09-20 |
| 1144702572 | Constance Baab, Phd, Lmsw, Pllc | Social Worker | 3301 Veterans Drive Suite 127, Traverse City, MI 49684 | 2018-09-01 |
| 1346732880 | The Skin Cancer and Dermatology Center Plc | Dermatology | 1225 W Front St Ste 2, Traverse City, MI 49684 | 2018-05-31 |
| 1790283851 | Lisa Louise Kleyps | Massage Therapist | 3337 W. South Airport Road #2, Traverse City, MI 49684 | 2018-01-24 |
| 1114447646 | Brittany Alexandra Prior | Physical Therapist | 3899 W Front Sreet, Unit 3, Traverse City, MI 49684 | 2017-06-26 |
| 1568902963 | Jennifer Scott | Behavior Technician | 515 W 14th St Unit D, Traverse City, MI 49684 | 2017-03-03 |
| Find all providers in zip 49684 | ||||
| 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 |
|---|---|---|---|---|
| 1568759314 | William Phillip Potthoff Jr. | Ophthalmology | 601 S Garfield Ave Ste A, Traverse City, MI 49686-3481 | 2011-06-30 |
| 1093877375 | Kenneth B Gum | Ophthalmology | 5199 N Royal Dr, Traverse City, MI 49684-9201 | 2006-12-14 |
| 1952463143 | Amy S Ranger | Ophthalmology | 4033 Eastern Sky Dr, Traverse City, MI 49684-7349 | 2006-12-14 |
| 1801998182 | Northern Vision Eye Care, PC | Ophthalmology | 4033 Easter Sky Drive, Traverse City, MI 49684 | 2006-09-05 |
| 1699750356 | Martin Samuel Arkin | Ophthalmology | 10161 E Pickwick Ct, Suite C, Traverse City, MI 49684-5239 | 2005-12-14 |
| 1821087560 | Peter D Fedor | Ophthalmology | 872 Munson Ave, Suite B, Traverse City, MI 49686-3638 | 2005-10-16 |
| 1770577637 | The Surgery Center | Ophthalmology | 5080 N Royal Dr, Traverse City, MI 49684-9230 | 2005-09-07 |
| 1598759821 | Kenneth H Musson | Ophthalmology | 929 Business Park Dr, Traverse City, MI 49686-8683 | 2005-09-01 |
| 1851383129 | Bradley S Hochstetler | Ophthalmology | 3830 W Front St, Traverse City, MI 49684-8153 | 2005-08-22 |
| 1780686485 | Kean T Oh | Ophthalmology | 860 East Front Street, Traverse City, MI 49686-2704 | 2005-08-12 |
| Find all providers in TRAVERSE CITY | ||||
| City | TRAVERSE CITY |
| Zip Code | 49684 |
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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.