JACK ROY OD
NPI 1770150419
Optometrist in Royal Oak, MI
About Jack Roy Od NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACK ROY OD (NPI 1770150419) is an individual optometrist in Royal Oak, Michigan, licensed in Michigan (4901005547) and active in the NPI registry since June 2021. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jack Roy Od is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Jack Roy reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Rochester Hills, MI 48307
- Reassigned Medicare billing, Michigan enrollment
- 51 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 48073 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jack Roy's NPI number?
The NPI number for Jack Roy is 1770150419. It was assigned to this individual provider in the NPPES registry on June 10, 2021.
Where is Jack Roy located?
Jack Roy practices at 30955 Woodward Ave Ste 215, Royal Oak, MI 48073. The listed phone number is (248) 873-0069.
What is Jack Roy's specialty?
The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.
Is Jack Roy enrolled in Medicare?
Yes. Jack Roy is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Jack Roy's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jack Roy reassigns Medicare benefits to Visionworks, Inc (Rochester Hills, MI). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jack Roy's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Jack Roy accept?
Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Anthem Blue Cross and Blue Shield and Blue Cross Blue Shield of Wyoming and 13 other insurers list Jack Roy as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Jack Roy was last updated on November 16, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jack Roy, OD · NPI 1770150419
Optometrist provider in Royal Oak, Michigan. Individual provider, active in the CMS NPPES registry since June 10, 2021.
## Identity
- **NPI:** 1770150419 (Entity type: Individual)
- **Enumerated:** June 10, 2021
- **Primary specialty:** Optometrist · taxonomy 152W00000X
- **State license:** 4901005547 (Michigan)
- **Sole proprietor:** No
## Practice location
- **Address:** 30955 WOODWARD AVE STE 215, Royal Oak, MI 48073-0801
- **Phone:** (248) 873-0069
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
- **Bills Medicare through:** Visionworks, Inc (NPI 1366822991, Rochester Hills, MI), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 16, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1770150419) · Data from the CMS NPPES public registry.