NPIMap

Organization Active NPI

Killingly Eye Care P.C.

  • Corneal and Contact Management Optometrist
  • Danielson, CT
National Provider Identifier
1255439188
Registry record updated Oct 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Corneal and Contact Management OptometristTaxonomy code 152WC0802X
License
864 Issued in CT
Legal business name
KILLINGLY EYE CARE P.C.
Practice address
25 Green Hollow Rd
Danielson, CT 06239-3509
Phone
(860) 779-1588
Fax
(860) 779-1754
NPI assigned
Sep 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2010

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

Authorized official

Name
Dr. James L Boccuzzi, O.D.
Title
President
Phone
(860) 779-1588

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152WC0802X 864 CT Primary

Addresses

Primary practice location

25 Green Hollow Rd
Danielson, CT 06239-3509

Mailing address

25 Green Hollow Rd
Danielson, CT 06239-3509
Phone (860) 779-1588

Other identifiers 2

IdentifierTypeStateIssuer
52KILLEYECT01OtherCTBLUE CROSS BLUE SHIELD
4188258MedicaidCT

Practitioners 5

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D1076210Killingly Eye Care PC25 Green Hollow Rd, Danielson, CT 06239Certificate of waiverNov 6, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Killingly Eye Care25 Green Hollow Rd, Danielson, CT 06239-3509(860) 779-1588 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 1998

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031124000219 CT Part B Supplier - Clinic/Group Practice 5294639001 Receives reassigned benefits from 5 practitioners
Practice locations: Danielson, CT
O20100930021085 CT DME Supplier - Physician - OptometristDME Supplier - Optician 5294639001 Practice locations: Danielson, CT

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287619200000",
    "number": "1255439188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 GREEN HOLLOW RD",
            "city": "DANIELSON",
            "state": "CT",
            "postal_code": "062393509",
            "telephone_number": "860-779-1588",
            "fax_number": "860-779-1754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 GREEN HOLLOW RD",
            "city": "DANIELSON",
            "state": "CT",
            "postal_code": "062393509",
            "telephone_number": "860-779-1588",
            "fax_number": "860-779-1754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KILLINGLY EYE CARE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2010-10-21",
        "status": "A",
        "authorized_official_last_name": "BOCCUZZI",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-779-1588",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CT",
            "license": "864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "52KILLEYECT01",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4188258",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danielson, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.