NPIMap

Organization Active NPI

Wild Apple Eye III LLC

  • Optometrist
  • Hebron, CT
National Provider Identifier
1346900412
Registry record updated Dec 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
WILD APPLE EYE III LLC
Practice address
34 Main St
Hebron, CT 06248-1515
Phone
(860) 228-2020
NPI assigned
Dec 30, 2021
Last updated
Dec 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2021

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

Authorized official

Name
Dr. Nicholas Paradis, ODNPI 1093243321
Title
Owner
Phone
(860) 391-3366

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 Primary

Addresses

Primary practice location

34 Main St
Hebron, CT 06248-1515

Mailing address

34 Main St
Hebron, CT 06248-1515
Phone (860) 228-2020

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220120000103 CT Part B Supplier - Clinic/Group Practice 5799177952 Receives reassigned benefits from 5 practitioners
Practice locations: Hebron, CT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1640822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640822400000",
    "number": "1346900412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 MAIN ST",
            "city": "HEBRON",
            "state": "CT",
            "postal_code": "062481515",
            "telephone_number": "860-228-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 MAIN ST",
            "city": "HEBRON",
            "state": "CT",
            "postal_code": "062481515",
            "telephone_number": "860-228-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD APPLE EYE III LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-30",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-30",
        "status": "A",
        "authorized_official_last_name": "PARADIS",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-391-3366",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hebron, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; 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.