Active NPI
Kerry Timothy Connell, O.D.
- Optometrist
- Saco, ME
National Provider Identifier
1093860082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT641
- Practice address
- 323 Main St
Saco, ME 04072-1514 - Phone
- (207) 284-4560
- Fax
- (207) 283-0309
- NPI assigned
- Jan 23, 2007
- Last updated
- May 13, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT641 | ME | Primary |
Addresses
Primary practice location
323 Main St
Saco, ME 04072-1514
Mailing address
323 Main St
Saco, ME 04072-1514
Phone (207) 284-4560
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8586932 | Other | ME | CIGNA |
| 109280499 | Medicaid | ME | |
| MNT1036 | Other | ME | HARVARD PILGRIM |
| 001138 | Other | ME | ANTHEM |
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
| License | State | Type | Specialty |
|---|---|---|---|
| OPT641 | ME | MD | Optometrist |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Optometrist
- Saco, ME
- NPI 1225155435
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210636800000",
"number": "1093860082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "323 MAIN ST",
"city": "SACO",
"state": "ME",
"postal_code": "040721514",
"telephone_number": "207-284-4560",
"fax_number": "207-283-0309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "323 MAIN ST",
"city": "SACO",
"state": "ME",
"postal_code": "040721514",
"telephone_number": "207-284-4560",
"fax_number": "207-283-0309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNELL",
"first_name": "KERRY",
"middle_name": "TIMOTHY",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-23",
"last_updated": "2008-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "ME",
"license": "OPT641",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "8586932",
"state": "ME"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "109280499",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "MNT1036",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "001138",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saco, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.