Individual provider Active NPI

Susan Gromacki Lathrop, O.D.

  • Optometrist
  • Fulton, MD
National Provider Identifier
1255371407
Registry record updated Dec 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TA2282 Issued in MD
Practice address
8115 Maple Lawn Blvd.
Suite 135
Fulton, MD 20759-2681
Phone
(301) 490-3036
Fax
(443) 288-4694
NPI assigned
Jun 7, 2006
Last updated
Dec 26, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901003970 MI
Optometrist 152W00000X TA2282 MD Primary

Addresses

Primary practice location

8115 Maple Lawn Blvd.
Suite 135
Fulton, MD 20759-2681

Mailing address

4868 Green Bridge Rd
Dayton, MD 21036-1211
Phone (410) 531-6967

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20200204002216 MD Practitioner - Optometry 7618968546 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ohio State University - College of Optometry, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
First Sight Vision Care LLCGroup PAC ID 3375794787, 3 clinicians

Practice addresses (Care Compare)

8115 Maple Lawn Blvd
Suite 135
Fulton, MD 20759-2681
Phone (301) 490-3036

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
First Sight Vision Care LLC CurrentSince Nov 4, 2019 Accepting new patients
Hudson Valley Eye Surgeons Past Accepting new patients
James a. Loreto Past Accepting new patients

Locations

8115 Maple Lawn Blvd
Ste 135
Fulton, MD 20759
Phone (301) 490-3036

Organizations & group practices 3

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": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577318400000",
    "number": "1255371407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4868 GREEN BRIDGE RD",
            "city": "DAYTON",
            "state": "MD",
            "postal_code": "210361211",
            "telephone_number": "410-531-6967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8115 MAPLE LAWN BLVD.",
            "address_2": "SUITE 135",
            "city": "FULTON",
            "state": "MD",
            "postal_code": "207592681",
            "telephone_number": "301-490-3036",
            "fax_number": "443-288-4694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATHROP",
        "first_name": "SUSAN",
        "middle_name": "GROMACKI",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-07",
        "last_updated": "2019-12-26",
        "certification_date": "2019-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003970",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA2282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fulton, MD

Sources for this page

Verify at the official NPI Registry.