Individual provider Active NPI

Shraiy Agrawal

  • Optometrist
  • Guilford, CT
National Provider Identifier
1194565903
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3350 Issued in CT
Practice address
200B Village Walk
Guilford, CT 06437-2745
Phone
(203) 458-2020
NPI assigned
May 29, 2024
Last updated
Jul 22, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Optometrist 152W00000X 009990 NY
Optometrist 152W00000X 3350 CT Primary

Addresses

Primary practice location

200B Village Walk
Guilford, CT 06437-2745

Mailing address

375 E Main St Unit 9
Branford, CT 06405-2963
Phone (347) 406-2276

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240731001551 CT Practitioner - Optometry 5799222444 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Doctors Optometrists PLLCGroup PAC ID 3375606940, 6 clinicians
Branford Optometric Associates PCGroup PAC ID 1951427640, 3 clinicians

Practice addresses (Care Compare)

200 Village Walk
Suite B
Guilford, CT 06437-2755
Phone (203) 458-2020

60 Montowese St
Branford, CT 06405-3857
Phone (203) 488-9544

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
009990NYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Branford Optometric Associates PC Optometrist CurrentSince Jul 14, 2024 Accepting new patients
Eye Doctors Optometrists PLLC Optometrist CurrentSince Jul 22, 2024 Accepting new patients

Locations

1 High St
Deep River, CT 06417
Phone (860) 388-2020

200 Village Walk
Ste B
Guilford, CT 06437
Phone (203) 458-2020

200B Village Walk
Guilford, CT 06437
Phone (203) 458-2020

1156 Boston Post Rd
Old Saybrook, CT 06475
Phone (860) 388-2020

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1716940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1194565903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 E MAIN ST UNIT 9",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064052963",
            "telephone_number": "347-406-2276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200B VILLAGE WALK",
            "city": "GUILFORD",
            "state": "CT",
            "postal_code": "064372745",
            "telephone_number": "203-458-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGRAWAL",
        "first_name": "SHRAIY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-05-29",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "009990",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "3350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Guilford, CT

Sources for this page

Verify at the official NPI Registry.