NPIMap

Organization Active NPI

Stamford Ophthalmology, LLC

  • Specialist
  • Stamford, CT
National Provider Identifier
1295814093
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
STAMFORD OPHTHALMOLOGY, LLC
Practice address
1351 Washington Blvd
Stamford, CT 06902-2419
Phone
(203) 325-0805
Fax
(203) 352-5199
NPI assigned
Nov 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

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

Authorized official

Name
Dr. Elizabeth Siderides, MDNPI 1134203953
Title
Owner
Phone
(203) 327-5808

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

1351 Washington Blvd
Stamford, CT 06902-2419

Mailing address

1351 Washington Blvd Ste 101
Stamford, CT 06902-2419
Phone (203) 325-0805

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040204000521 CT Part B Supplier - Clinic/Group Practice 6507759529 Receives reassigned benefits from 9 practitioners
Practice locations: Stamford, CT

National Provider Directory

National Provider Directory
Tax ID family
Stamford Ophthalmology2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1351 Washington Blvd
Ste 101
Stamford, CT 06902
Phone (203) 325-0805

Practitioners & affiliated clinicians

Practitioners 12

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": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1295814093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351 WASHINGTON BLVD STE 101",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069022419",
            "telephone_number": "203-325-0805",
            "fax_number": "203-352-5199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1351 WASHINGTON BLVD",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069022419",
            "telephone_number": "203-325-0805",
            "fax_number": "203-352-5199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAMFORD OPHTHALMOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "SIDERIDES",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-327-5808",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stamford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; 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.