NPIMap

Individual provider Active NPI

Kristin B Tallman, O.D.

  • Optometrist
  • Lawrence, MA
National Provider Identifier
1083697361
Registry record updated Nov 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3841 Issued in MA
Practice address
360 Merrimack St
BLDG 9, Entrance I
Lawrence, MA 01843-1740
Phone
(978) 688-6182
Fax
(978) 689-0731
NPI assigned
Nov 21, 2005
Last updated
Nov 25, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3841 MA Primary

Addresses

Primary practice location

360 Merrimack St
BLDG 9, Entrance I
Lawrence, MA 01843-1740

Mailing address

360 Merrimack St
BLDG 9, Entrance I
Lawrence, MA 01843-1740
Phone (978) 688-6182

Other identifiers 1

IdentifierTypeStateIssuer
110017615AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3841MAMDPhysical Rehabilitation Occupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385337600000",
    "number": "1083697361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 MERRIMACK ST",
            "address_2": "BLDG 9, ENTRANCE I",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "018431740",
            "telephone_number": "978-688-6182",
            "fax_number": "978-689-0731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 MERRIMACK ST",
            "address_2": "BLDG 9, ENTRANCE I",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "018431740",
            "telephone_number": "978-688-6182",
            "fax_number": "978-689-0731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TALLMAN",
        "first_name": "KRISTIN",
        "middle_name": "B",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-21",
        "last_updated": "2013-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "3841",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110017615A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrence, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.