Sandra C Kellett, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

VUT005605-1 Issued in NY

Practice address

3630 Hill Blvd
Suite 303
Jefferson Valley, NY 10535-1502

Phone

(914) 962-8111

Fax

(914) 962-8160

NPI assigned

Sep 12, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Optometry

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sandra Cammilleri Kellett OD, Faao, PC

  • Optometrist
  • Jefferson Valley, NY
  • NPI 1639350911
  Medicare reassignment NPD Authorized official
• Lighthouse International

  • Clinic/Center
  • White Plains, NY
  • NPI 1851346936
  NPD (past)

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195084800000",
    "number": "1174627715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3630 HILL BLVD",
            "address_2": "SUITE 303",
            "city": "JEFFERSON VALLEY",
            "state": "NY",
            "postal_code": "105351502",
            "telephone_number": "914-962-8111",
            "fax_number": "914-962-8160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3630 HILL BLVD",
            "address_2": "SUITE 303",
            "city": "JEFFERSON VALLEY",
            "state": "NY",
            "postal_code": "105351502",
            "telephone_number": "914-962-8111",
            "fax_number": "914-962-8160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLETT",
        "first_name": "SANDRA",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-12",
        "last_updated": "2007-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "VUT005605-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET OF THE NORTHEAS",
            "identifier": "3C0168",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MED DURABLE MEDICAL EQUIP",
            "identifier": "4242180001",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BLUE CROSS/SHIELD",
            "identifier": "C23392",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "597002",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIP",
            "identifier": "17390P",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTH HMO",
            "identifier": "2508518",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTH PPO",
            "identifier": "5714530",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTIPLAN",
            "identifier": "P-11097425",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P677288",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLUE CROSS",
            "identifier": "C23392",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jefferson Valley Pediatric Dentistry
• Jefferson Valley Pharmacy Inc
• Jefferson Valley Podiatry Associates, P.C.
• Jeffrey P Schachne MD
• Marc P Kaufman, DDS
• Arlinda Kelmendi
• Raymond J Kolkmann
• Deborah A Lenihan, PT
• Alisha Lenora Liggett, MD
• Robert Anthony Lois, D.C.

• Optometrist in Jefferson Valley, NY
• Providers in Jefferson Valley, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.