Active NPI
Ronald J Serra, OD
- Optometrist
- Westerly, RI
National Provider Identifier
1124060397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- ODGT486
- Practice address
- 17 Wells Street
Westerly, RI 02891 - Phone
- (401) 348-2020
- Fax
- (401) 596-9348
- NPI assigned
- Jun 12, 2006
- 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 | ODGT486 | RI | Primary |
Addresses
Primary practice location
17 Wells Street
Westerly, RI 02891
Mailing address
17 Wells Street
Westerly, RI 02891
Phone (401) 348-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9009837 | Medicaid | RI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ODGT486 | RI | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335312000000",
"number": "1124060397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 WELLS STREET",
"city": "WESTERLY",
"state": "RI",
"postal_code": "02891",
"telephone_number": "401-348-2020",
"fax_number": "401-596-9348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 WELLS STREET",
"city": "WESTERLY",
"state": "RI",
"postal_code": "02891",
"telephone_number": "401-348-2020",
"fax_number": "401-596-9348"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SERRA",
"first_name": "RONALD",
"middle_name": "J",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-12",
"last_updated": "2012-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "RI",
"license": "ODGT486",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9009837",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Westerly, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2012; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.