Maureen Kimora Wallen, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV006882 Issued in NY

Practice address

5700 West Genesee Street
Suite 112
Camillus, NY 13031

Phone

(315) 488-1601

Fax

(315) 488-0047

NPI assigned

Dec 1, 2005

Last updated

Apr 1, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Maureen Kimora Rolf Former name

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Optometry

Education

State University of New York - State College Optometry, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Robert K Druger MD PLLCGroup PAC ID 1456325653, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: drmaureenwallen@drugereyecare.medentdirect.com

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.

• Robert K Druger MD PLLC

  dba Druger Eye Care

  • Ophthalmology Physician
  • Camillus, NY
  • NPI 1730132291
  Medicare reassignment Care Compare group
• Highland Ophthalmology Associates LLC

  • Ophthalmology Physician
  • New Windsor, NY
  • NPI 1184796591
  NPD (past)
• State of New York Comptrollers Office

  • Developmental Disabilities Clinic/Center
  • Staten Island, NY
  • NPI 1750469912
  NPD (past)

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270080000000",
    "number": "1285618439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 WEST GENESEE STREET",
            "address_2": "SUITE 112",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "13031",
            "telephone_number": "315-488-1601",
            "fax_number": "315-488-0047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 WEST GENESEE STREET",
            "address_2": "SUITE 112",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "13031",
            "telephone_number": "315-488-1601",
            "fax_number": "315-488-0047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLEN",
        "first_name": "MAUREEN",
        "middle_name": "KIMORA",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-01",
        "last_updated": "2010-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV006882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAUREEN",
            "last_name": "ROLF",
            "middle_name": "KIMORA",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Josierem Concellado Waite, RN
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2581)
• Wal-Mart Stores East, LP (Vision Center 30-2581)
• Walgreen Co (Walgreens #09413)
• Walgreen Co (Rite Aid)
• Rebecca Wassel, PTA
• Tekhara Watson, LMFT
• Coreena L Weaver, MD
• Donna Mary Weckerle, AU.D.
• Ruthanne K Weinheimer, LCSW

• Optometrist in Camillus, NY
• Providers in Camillus, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.