Active NPI
Nicole Frances Theiss, O.D.
- Optometrist
- Burlington, MA
National Provider Identifier
1174077036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 5160
- Practice address
- 74 Burlington Mall Rd
Burlington, MA 01803-4518 - Phone
- (781) 272-5620
- NPI assigned
- Aug 9, 2016
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 5160 | MA | Primary |
Addresses
Primary practice location
74 Burlington Mall Rd
Burlington, MA 01803-4518
Mailing address
74 Burlington Mall Rd
Burlington, MA 01803-4518
Phone (781) 272-5620
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5160 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474934400000",
"number": "1174077036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "74 BURLINGTON MALL RD",
"city": "BURLINGTON",
"state": "MA",
"postal_code": "018034518",
"telephone_number": "781-272-5620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "74 BURLINGTON MALL RD",
"city": "BURLINGTON",
"state": "MA",
"postal_code": "018034518",
"telephone_number": "781-272-5620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEISS",
"first_name": "NICOLE",
"middle_name": "FRANCES",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-08-09",
"last_updated": "2016-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MA",
"license": "5160",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burlington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.