James Hovannes Fantazian, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2093 Issued in MA

Practice address

247 Boston Rd
N Billerica, MA 01862

Phone

(978) 667-6151

Fax

(978) 667-4422

NPI assigned

Sep 26, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1225139744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 356",
            "address_2": "247 BOSTON RD",
            "city": "N BILLERICA",
            "state": "MA",
            "postal_code": "01862",
            "telephone_number": "978-667-6151",
            "fax_number": "978-667-4422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "247 BOSTON RD",
            "city": "N BILLERICA",
            "state": "MA",
            "postal_code": "01862",
            "telephone_number": "978-667-6151",
            "fax_number": "978-667-4422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANTAZIAN",
        "first_name": "JAMES",
        "middle_name": "HOVANNES",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "2093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0304999",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in N Billerica, MA
• Providers in N Billerica, MA by specialty
• Optometrist in Massachusetts

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.