NPIMap

Organization Active NPI

Ejc Eyecare, LLC

Doing business as Community Opticians

  • Optometrist
  • Waltham, MA
National Provider Identifier
1235368275
Registry record updated Apr 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
MA3675 Issued in MA
Legal business name
EJC EYECARE, LLC
Doing business as
Community Opticians
Practice address
362 Moody St
Waltham, MA 02453-5204
Phone
(781) 894-0081
Fax
(781) 894-9361
NPI assigned
Jul 13, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2014

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

Authorized official

Name
Dr. Stephanie Ann Paris-Whitney, O.D.NPI 1265424758
Title
Owner
Phone
(781) 894-0081

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X MA3675 MA Primary

Addresses

Primary practice location

362 Moody St
Waltham, MA 02453-5204

Mailing address

362 Moody St
Waltham, MA 02453-5204
Phone (781) 894-0081

Other names 1

  • Community Opticians Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090914000266 MA Part B Supplier - Clinic/Group Practice 6901952134 Receives reassigned benefits from 5 practitioners
Practice locations: Waltham, MA

National Provider Directory

National Provider Directory

Locations

289 Moody St
Waltham, MA 02453
Phone (781) 894-0081

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1247443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398816000000",
    "number": "1235368275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "362 MOODY ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024535204",
            "telephone_number": "781-894-0081",
            "fax_number": "781-894-9361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "362 MOODY ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024535204",
            "telephone_number": "781-894-0081",
            "fax_number": "781-894-9361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EJC EYECARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-13",
        "last_updated": "2014-04-30",
        "status": "A",
        "authorized_official_last_name": "PARIS-WHITNEY",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-894-0081",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MA",
            "license": "MA3675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Opticians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waltham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.