Individual provider Active NPI

Amy Himmelstein

  • Optometrist
  • Bristol, CT
National Provider Identifier
1245257153
Registry record updated May 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1085 Issued in CT
Practice address
440 N Main St Ste B
Bristol, CT 06010-1902
Phone
(860) 582-2166
Fax
(860) 582-8044
NPI assigned
Jul 16, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1085 CT Primary

Addresses

Primary practice location

440 N Main St Ste B
Bristol, CT 06010-1902

Mailing address

440 N Main St Ste B
Bristol, CT 06010-1902
Phone (860) 582-2166

Other identifiers 2

IdentifierTypeStateIssuer
004133823MedicaidCT
410000961OtherMEDICARE ID - TYPE UNSPECIFIED

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
I20120717000658 CT Practitioner - Optometry 8820110661 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

440 N Main St
Suite B
Bristol, CT 06010-1902
Phone (860) 582-2166

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1085CTMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Optometric Associates of Bristol, LLC Optometrist CurrentSince Apr 26, 2012 Accepting new patients
Optometric Associates of Bristol, LLC CurrentSince Apr 26, 2012 Accepting new patients

Locations

751 Farmington Ave
Bristol, CT 06010
Phone (860) 582-2166

440 N Main St
Ste B
Bristol, CT 06010
Phone (860) 582-2166

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716940800000",
    "number": "1245257153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 N MAIN ST STE B",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060101902",
            "telephone_number": "860-582-2166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 N MAIN ST STE B",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060101902",
            "telephone_number": "860-582-2166",
            "fax_number": "860-582-8044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HIMMELSTEIN",
        "first_name": "AMY",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-16",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "1085",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004133823",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID - TYPE UNSPECIFIED",
            "identifier": "410000961",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, CT

Sources for this page

Verify at the official NPI Registry.