NPIMap

Organization Active NPI

Kathleen M. Cleary , OD. PC

  • Optometrist
  • Quincy, MA
National Provider Identifier
1295958486
Registry record updated Jul 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3420 Issued in MA
Legal business name
KATHLEEN M. CLEARY , OD. PC
Practice address
470 Southern Artery
Quincy, MA 02169-4614
Phone
(617) 773-8050
Fax
(617) 770-9453
NPI assigned
Apr 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2010

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

Authorized official

Name
Kathleen Monica Cleary, O.D.NPI 1972586022
Title
Doctor of Optometry
Phone
(617) 773-8050

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
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 3420 MA Primary

Addresses

Primary practice location

470 Southern Artery
Quincy, MA 02169-4614

Mailing address

470 Southern Artery
Quincy, MA 02169-4614
Phone (617) 773-8050

Other identifiers 2

IdentifierTypeStateIssuer
0392154MedicaidMA
9703616MedicaidMA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101008000402 MA Part B Supplier - Clinic/Group Practice 4183816150 Receives reassigned benefits from 3 practitioners
Practice locations: Quincy, MA

National Provider Directory

National Provider Directory

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": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278374400000",
    "number": "1295958486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "470 SOUTHERN ARTERY",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021694614",
            "telephone_number": "617-773-8050",
            "fax_number": "617-770-9453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 SOUTHERN ARTERY",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021694614",
            "telephone_number": "617-773-8050",
            "fax_number": "617-770-9453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATHLEEN M. CLEARY , OD. PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2010-07-06",
        "status": "A",
        "authorized_official_last_name": "CLEARY",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "MONICA",
        "authorized_official_title_or_position": "DOCTOR OF OPTOMETRY",
        "authorized_official_telephone_number": "617-773-8050",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MA",
            "license": "3420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0392154",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9703616",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 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.