Active NPI
Jake Duclos Fiore, OD
- Optometrist
- Waltham, MA
National Provider Identifier
1104556232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 5569
- Practice address
- 289 Moody St
Waltham, MA 02453-5284 - Phone
- (781) 894-2127
- NPI assigned
- Jun 13, 2022
- Last updated
- Nov 1, 2022
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 5569 | MA | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
289 Moody St
Waltham, MA 02453-5284
Mailing address
289 Moody St
Waltham, MA 02453-5284
Phone (781) 894-2127
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Other, 2022
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
289 Moody St
Waltham, MA 02453-5284
Phone (781) 894-0081
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5569 | MA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ejc Eyecare, LLC | Optometrist | Current | Accepting new patients |
Locations
289 Moody St
Waltham, MA 02453
Phone (781) 894-0081
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667260800000",
"number": "1104556232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "289 MOODY ST",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024535284",
"telephone_number": "781-894-2127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "289 MOODY ST",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024535284",
"telephone_number": "781-894-2127"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FIORE",
"first_name": "JAKE",
"middle_name": "DUCLOS",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-13",
"last_updated": "2022-11-01",
"certification_date": "2022-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MA",
"license": "5569",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.