Individual provider Active NPI

Connie Nguyen

  • Optometrist
  • Boston, MA
National Provider Identifier
1265251805
Registry record updated Feb 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT8248 Issued in MA
Practice address
19 Peterborough St Apt 5
Boston, MA 02215-4409
Phone
(860) 707-2037
NPI assigned
Oct 9, 2024
Last updated
Feb 24, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT8248 MA Primary

Addresses

Primary practice location

19 Peterborough St Apt 5
Boston, MA 02215-4409

Mailing address

19 Peterborough St Apt 5
Boston, MA 02215-4409
Phone (860) 707-2037

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20251222000623 MA Practitioner - Optometry 1456840248 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1340 Boylston St
Boston, MA 02215-4302
Phone (617) 267-0900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT8248MAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Fenway Community Health Center, Inc CurrentSince Oct 13, 2025 Accepting new patients
Fenway Community Health Center, Inc CurrentSince Oct 13, 2025 Accepting new patients
Redstone Eye Associates, LLC Optometrist CurrentSince Dec 28, 2025 Accepting new patients

Locations

1340 Boylston St
Boston, MA 02215
Phone (617) 247-7555

75 Main St
Stoneham, MA 02180
Phone (781) 438-2505

Interoperability endpoints

  • Direct secure messaging: cnguyen47390@direct.ctc.masshiway.net

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": "1728432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740355200000",
    "number": "1265251805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 PETERBOROUGH ST APT 5",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022154409",
            "telephone_number": "860-707-2037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 PETERBOROUGH ST APT 5",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022154409",
            "telephone_number": "860-707-2037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "CONNIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-09",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "OPT8248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.