Active NPI
Gary Lee Vrooman, OD
- Optometrist
- E Hartford, CT
National Provider Identifier
1154410561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 816
- Practice address
- 596 Burnside Ave
E Hartford, CT 06108 - Phone
- (860) 528-6819
- NPI assigned
- Oct 12, 2006
- Last updated
- Jul 8, 2007
- 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 | 816 | CT | Primary |
Addresses
Primary practice location
596 Burnside Ave
E Hartford, CT 06108
Mailing address
596 Burnside Ave
E Hartford, CT 06108
Phone (860) 528-6819
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110427000712 | CT | Practitioner - Optometry | 3476738907 | Practice locations: East Hartford, CT |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 816 | CT | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154410561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "596 BURNSIDE AVE",
"city": "E HARTFORD",
"state": "CT",
"postal_code": "06108",
"telephone_number": "860-528-6819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "596 BURNSIDE AVE",
"city": "E HARTFORD",
"state": "CT",
"postal_code": "06108",
"telephone_number": "860-528-6819"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VROOMAN",
"first_name": "GARY",
"middle_name": "LEE",
"name_prefix": "Mr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CT",
"license": "816",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in E Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.