Active NPI
Patricia Ann Carpenter
- Optician
- Rockford, IL
National Provider Identifier
1295908341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 23903228
- Practice address
- 130 N 1St St
Rockford, IL 61107-3900 - Phone
- (815) 965-2989
- NPI assigned
- Apr 9, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 23903228 | IL | Primary |
Addresses
Primary practice location
130 N 1St St
Rockford, IL 61107-3900
Mailing address
130 N 1St St
Rockford, IL 61107-3900
Phone (815) 965-2989
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295290001 | Other | IL | BILLING PROVIDER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23903228 | IL | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207699200000",
"number": "1295908341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 N 1ST ST",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611073900",
"telephone_number": "815-965-2989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 N 1ST ST",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611073900",
"telephone_number": "815-965-2989"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARPENTER",
"first_name": "PATRICIA",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-09",
"last_updated": "2008-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "IL",
"license": "23903228",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BILLING PROVIDER",
"identifier": "1295290001",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.