PROFESSIONAL OPTICAL LLC (NPI# 1790846533) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1790846533 |
Entity Type | Organization |
Organization Name | PROFESSIONAL OPTICAL LLC |
Practice Address |
560 W Mitchell St Suite#204 Petoskey MI 49770-2275 |
Practice Telephone | 2314870171 |
Mailing Telephone | 2314870171 |
Mailing Fax Number | 2314870690 |
Enumeration Date | 2006-12-13 |
Last Update Date | 2008-07-17 |
Authorized Official Name | MR. DAVID DZIAK (MEMBER) |
Authorized Official Telephone | 2314870171 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MI | MI BCBS | 540B411030 | 01 |
Street Address |
560 W MITCHELL ST SUITE#204 |
City | PETOSKEY |
State | MI |
Zip Code | 49770-2275 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1437156940 | Melanie S Manary | Internal Medicine | 560 W Mitchell St, Ste 300, Petoskey, MI 49770-2278 | 2005-06-30 |
1346862455 | Mclaren Central Michigan | Clinic/Center | 560 W Mitchell St, Petoskey, MI 49770-2275 | 2020-05-12 |
1841732617 | Dawn Ebersole | Nurse Practitioner | 560 W Mitchell St, Suite M40, Petoskey, MI 49770-2275 | 2016-11-10 |
1689025363 | Kasey Peltier | Nurse Practitioner | 560 W Mitchell St, Suite 505, Petoskey, MI 49770-2275 | 2016-06-24 |
1912390741 | Twin Oaks Mental Health Center, LLC | Clinic/Center | 560 W Mitchell St, Suite 208, Petoskey, MI 49770-2275 | 2015-03-18 |
1053728840 | Kristi Lynn Dipzinski | Nurse Practitioner | 560 W Mitchell St, Suite 300, Petoskey, MI 49770-2275 | 2014-07-14 |
1609281401 | Cale M Sebald | Internal Medicine | 560 W Mitchell St, Petoskey, MI 49770-2275 | 2014-07-01 |
1942629530 | Robin Brooks | Audiologist | 560 W Mitchell St, Petoskey, MI 49770-2275 | 2014-04-10 |
1295074128 | Lindsay Ann Potts | Physician Assistant | 560 W Mitchell St, Suite 505, Petoskey, MI 49770-2275 | 2013-02-13 |
1720327695 | Harbor Neurology Plc | Psychiatry & Neurology | 560 W Mitchell St, Suite 350, Petoskey, MI 49770-2275 | 2013-02-12 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1780231985 | Olivia Michelle Seaman | Pharmacist | 1301 U.S. 31 N. Hwy, Petoskey, MI 49770 | 2019-08-22 |
1649733148 | Harbor Hall, Inc. | Clinic/Center | 302 Orchard Ridge Drive, Petoskey, MI 49770 | 2019-04-11 |
1053802942 | Devin Hueston | Dentist | 231 State St Ste 3, Petoskey, MI 49770 | 2018-05-25 |
1720585037 | Jacob Kenneth Tracy | Counselor | 410 E Lake Street, Suite 100, Petoskey, MI 49770 | 2018-04-12 |
1013424191 | Timothy Robert La Gasse | Nurse Practitioner | 401 Connable Ave, Petoskey, MI 49770 | 2018-01-10 |
1609303676 | Shauna Sue Stark | Nurse Practitioner | 560 W Mitchell St Ste 505, Petoskey, MI 49770 | 2017-05-22 |
1053851519 | Maureen Todd | Counselor | 703 Emmet St, Petoskey, MI 49770 | 2017-03-03 |
1457719239 | Hufford Vision & Eye Care, PC | Optometrist | 560 West Mitchell, Suite 214, Petoskey, MI 49770 | 2016-02-08 |
1053779439 | Kaylyn Schiemann | Specialist/Technologist | 1980 Maxwell Rd, Petoskey, MI 49770 | 2016-02-01 |
1669839130 | Stieber Pediatric Dentistry Pllc | Clinic/Center | 1605 Us 131 Highway, Petoskey, MI 49770 | 2016-01-28 |
Find all providers in zip 49770 |
Taxonomy Code | 332H00000X |
Grouping | Suppliers |
Classification | Eyewear Supplier (Equipment, not the service) |
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1528072436 | Jcs Optical Inc. | Eyewear Supplier (Equipment, not the service) | 1159 N Us Highway 31, Petoskey, MI 49770-9305 | 2006-07-28 |
1881731248 | North Bay Ophthalmology, PC | Eyewear Supplier (Equipment, not the service) | 2061 M 119, Petoskey, MI 49770-8914 | 2007-02-01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1245831783 | Anthony Curtis Mcconer Sr. | Eyewear Supplier (Equipment, not the service) | 457 Highland St Se, Grand Rapids, MI 49507-1204 | 2020-11-02 |
1164023610 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 3355 Henry St Ste H, Muskegon, MI 49441-4393 | 2020-11-02 |
1316545155 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 15523 Racho Blvd, Taylor, MI 48180-5213 | 2020-10-14 |
1043818859 | Svs Vision Inc | Eyewear Supplier (Equipment, not the service) | 6828 Rochester Rd, Troy, MI 48085-1291 | 2020-10-14 |
1851999692 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 45101 Towne Center Blvd, Chesterfield, MI 48047-6141 | 2020-10-14 |
1609488378 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 4816 Bay City Rd, Midland, MI 48642 | 2020-08-23 |
1831700061 | Optics Center | Eyewear Supplier (Equipment, not the service) | 6645 Schaefer Rd, Dearborn, MI 48126-1812 | 2020-08-11 |
1538784327 | Sassy Eyes Boutique, LLC | Eyewear Supplier (Equipment, not the service) | 28911 7 Mile Rd, Livonia, MI 48152-3503 | 2020-06-08 |
1508407982 | P-cor LLC | Eyewear Supplier (Equipment, not the service) | 1961 S. Telegraph Rd, Bloomfield Hills, MI 48302 | 2019-10-07 |
1972153666 | Svs Vision Inc | Eyewear Supplier (Equipment, not the service) | 15620 Hall Rd, Clinton Township, MI 48038-1036 | 2019-09-16 |
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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.