Individual provider Active NPI

Allie Decker, OD

  • Optometrist
  • Southport, CT
National Provider Identifier
1003545658
Registry record updated Feb 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3266 Issued in CT
Practice address
2600 Post Rd
Southport, CT 06890-3206
Phone
(203) 255-4005
NPI assigned
Jun 8, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Optometrist 152WP0200X 3266 CT
Vision Therapy Optometrist 152WV0400X 3266 CT
Optometrist 152W00000X 3266 CT Primary

Addresses

Primary practice location

2600 Post Rd
Southport, CT 06890-3206

Mailing address

100 Woodside CT Unit 8405
Trumbull, CT 06611-4991

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250130001554 ME Practitioner - Optometry 2567991961 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eyes on Rosemont LLCGroup PAC ID 0042359515, 4 clinicians

Practice addresses (Care Compare)

595 Brighton Ave
Portland, ME 04102-2322
Phone (207) 210-6700

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3266CTMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Eyes on Rosemont LLC Vision Therapy CurrentSince Dec 18, 2024 Accepting new patients

Locations

152 Middle St
Portland, ME 04101
Phone (207) 773-2020

595 Brighton Ave
Portland, ME 04102
Phone (207) 210-6700

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707868800000",
    "number": "1003545658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 WOODSIDE CT UNIT 8405",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066114991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 POST RD",
            "city": "SOUTHPORT",
            "state": "CT",
            "postal_code": "068903206",
            "telephone_number": "203-255-4005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECKER",
        "first_name": "ALLIE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-08",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "CT",
            "license": "3266",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "CT",
            "license": "3266",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "3266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southport, CT

Sources for this page

Verify at the official NPI Registry.