Active NPI
Donat Jutras, LO
- Optician
- Bristol, CT
National Provider Identifier
1154702041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 688
- Practice address
- 927 Farmington Ave
Bristol, CT 06010-3927 - Phone
- (860) 589-6475
- NPI assigned
- Jun 16, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Optician | 156FX1800X | 688 | CT | Primary |
Addresses
Primary practice location
927 Farmington Ave
Bristol, CT 06010-3927
Mailing address
927 Farmington Ave
Bristol, CT 06010-3927
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871690131 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434412800000",
"number": "1154702041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "927 FARMINGTON AVE",
"city": "BRISTOL",
"state": "CT",
"postal_code": "060103927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "927 FARMINGTON AVE",
"city": "BRISTOL",
"state": "CT",
"postal_code": "060103927",
"telephone_number": "860-589-6475"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUTRAS",
"first_name": "DONAT",
"credential": "LO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-06-16",
"last_updated": "2015-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "CT",
"license": "688",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1871690131",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bristol, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.