Individual provider Active NPI

Victoria L Dumont, O.D.

  • Optometrist
  • Gardner, MA
National Provider Identifier
1134119217
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3769 Issued in MA
Practice address
677 Timpany Blvd
Gardner, MA 01440
Phone
(978) 669-4094
Fax
(978) 632-1962
NPI assigned
Oct 28, 2005
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3769 MA Primary

Addresses

Primary practice location

677 Timpany Blvd
Gardner, MA 01440

Mailing address

719 New Sherborn Road
Athol, MA 01331
Phone (978) 669-4094

Other identifiers 2

IdentifierTypeStateIssuer
0369144MedicaidMA
110017590AMedicaidMA

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110726000606 MA Practitioner - Optometry 7416125083 Practice locations: Gardner, MA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

677 Timpany Blvd
Gardner, MA 01440-3452
Phone (978) 669-4094

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3769MAMDForensic Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1134119217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 NEW SHERBORN ROAD",
            "city": "ATHOL",
            "state": "MA",
            "postal_code": "01331",
            "telephone_number": "978-669-4094",
            "fax_number": "978-632-1962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "677 TIMPANY BLVD",
            "city": "GARDNER",
            "state": "MA",
            "postal_code": "01440",
            "telephone_number": "978-669-4094",
            "fax_number": "978-632-1962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUMONT",
        "first_name": "VICTORIA",
        "middle_name": "L",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-10-28",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "3769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0369144",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110017590A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gardner, MA

Sources for this page

Verify at the official NPI Registry.