Nutaporn Sukontasup, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

TA1848 Issued in MD

Practice address

8115 Maple Lawn Blvd
Suite 135
Fulton, MD 20759-2681

Phone

(443) 804-1173

NPI assigned

Aug 18, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Natalie Sukontasup Professional name

Medicare fee-for-service enrollment

Enrolled in MD

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

Specialty

Optometry

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

First Sight Vision Care LLCGroup PAC ID 3375794787, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• First Sight Vision Care LLC

  • Clinic/Center
  • Fulton, MD
  • NPI 1235489030
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484438400000",
    "number": "1104930817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8315 ACADEMY RD",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210436687",
            "telephone_number": "443-804-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8115 MAPLE LAWN BLVD",
            "address_2": "SUITE 135",
            "city": "FULTON",
            "state": "MD",
            "postal_code": "207592681",
            "telephone_number": "443-804-1173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUKONTASUP",
        "first_name": "NUTAPORN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-18",
        "last_updated": "2017-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA1848",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11431664",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NATALIE",
            "last_name": "SUKONTASUP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Victoria Ruth Staiman, M.D.
• Standard Medical Equipment Systems LLC
• Standard Medical Home Healthcare, LLC
• Leanne Staylor
• Mycala Strong
• Summit Ambulatory Surgical Center, LLC
• Surgipa Health, LLC
• Loretta Sutphin, M.D.
• Nicole Swan
• Samantha M Swords, MD

• Optometrist in Fulton, MD
• Providers in Fulton, MD by specialty
• Optometrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2017; 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.

Verify at the official NPI Registry.