Wild Apple Eye LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

WILD APPLE EYE LLC

Practice address

90 Main St Ste 101
Centerbrook, CT 06409-1057

Phone

(860) 767-3206

NPI assigned

Dec 26, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Nicholas Anthony Paradis, ODNPI 1093243321

Title

Optometrist

Phone

(860) 577-2012

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicholas Anthony Paradis, OD

  • Optometrist
  • Centerbrook, CT
  • NPI 1093243321
  Medicare reassignment Care Compare group NPD Authorized official
• Nicholas Paul Vezzoli, OD

  • Optometrist
  • Old Saybrook, CT
  • NPI 1194249722
  Medicare reassignment Care Compare group NPD
• Shirley M Curioso, O.D.

  • Optometrist
  • Centerbrook, CT
  • NPI 1063502102
  NPD (past)
• Mark Denegre

  • Optician
  • Centerbrook, CT
  • NPI 1659446342
  NPD (past)
• David L Macdonald, O.D.

  • Optometrist
  • Old Saybrook, CT
  • NPI 1740282896
  NPD (past)

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

{
    "created_epoch": "1577318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601337600000",
    "number": "1104465939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 BOKUM RD",
            "city": "OLD SAYBROOK",
            "state": "CT",
            "postal_code": "064751207",
            "telephone_number": "860-391-3366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 MAIN ST STE 101",
            "city": "CENTERBROOK",
            "state": "CT",
            "postal_code": "064091057",
            "telephone_number": "860-767-3206"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "484 Grayback Avenue",
            "address_2": "Building #4",
            "address_purpose": "LOCATION",
            "city": "Groton",
            "state": "CT",
            "postal_code": "06349",
            "country_code": "US",
            "telephone_number": "860-326-2247",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WILD APPLE EYE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-26",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A",
        "authorized_official_last_name": "PARADIS",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "860-577-2012",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8073265",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "A31568",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CTCARE",
            "identifier": "139866",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "4002760",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P5740240",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "12002152",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "1473930",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Catherine Rodgers Spagnola, APRN,CS
• Specialty RX Consulting LLC
• Specialty RX Consulting LLC
• Mary Tremalgia
• Visiting Nurses of the Lower Valley, Inc.

• Optometrist in Centerbrook, CT
• Providers in Centerbrook, CT by specialty
• Optometrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.