Organization Active NPI

West End Eye Care LLC

  • Optometrist
  • Hartford, CT
National Provider Identifier
1275684037
Registry record updated Mar 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
WEST END EYE CARE LLC
Practice address
553 Farmington Ave
Hartford, CT 06105-3048
Phone
(860) 236-5831
NPI assigned
Jan 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2010

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

Authorized official

Name
Dr. Jerry Hardison, O.D.
Title
Owner
Phone
(860) 236-5831

Specialties & licenses 1

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

Addresses

Primary practice location

553 Farmington Ave
Hartford, CT 06105-3048

Mailing address

553 Farmington Ave
Hartford, CT 06105-3048

Other identifiers 1

IdentifierTypeStateIssuer
4205250MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100305000547 CT Part B Supplier - Clinic/Group Practice 5496890105 Receives reassigned benefits from 3 practitioners
Practice locations: Hartford, CT

National Provider Directory

National Provider Directory

Locations

553 Farmington Ave
Hartford, CT 06105
Phone (860) 236-5831

Practitioners & affiliated clinicians

Practitioners 3

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": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267747200000",
    "number": "1275684037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "553 FARMINGTON AVE",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061053048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "553 FARMINGTON AVE",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061053048",
            "telephone_number": "860-236-5831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST END EYE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2010-03-05",
        "status": "A",
        "authorized_official_last_name": "HARDISON",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-236-5831",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4205250",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2010; 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.