Individual provider Active NPI

Domenic A. D'Angelo, O.D.

  • Optometrist
  • Saugus, MA
National Provider Identifier
1356401871
Registry record updated Sep 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3223 Issued in MA
Practice address
600 Broadway
Saugus, MA 01906-3201
Phone
(781) 231-2330
Fax
(781) 233-2050
NPI assigned
Dec 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 1, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3223 MA Primary

Addresses

Primary practice location

600 Broadway
Saugus, MA 01906-3201

Mailing address

600 Broadway
Saugus, MA 01906-3201
Phone (781) 231-2330

Other identifiers 1

IdentifierTypeStateIssuer
0353221MedicaidMA

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20120604000235 MA Practitioner - Optometry 4688838618 Practice locations: Saugus, MA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

600 Broadway
Saugus, MA 01906-3201
Phone (781) 231-2330

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3223MAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Domenic a. D'Angelo and Associates Optometrist PastSince Mar 31, 2011 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504224000000",
    "number": "1356401871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 BROADWAY",
            "city": "SAUGUS",
            "state": "MA",
            "postal_code": "019063201",
            "telephone_number": "781-231-2330",
            "fax_number": "781-233-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 BROADWAY",
            "city": "SAUGUS",
            "state": "MA",
            "postal_code": "019063201",
            "telephone_number": "781-231-2330",
            "fax_number": "781-233-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "D'ANGELO",
        "first_name": "DOMENIC",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2017-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "3223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0353221",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saugus, MA

Sources for this page

Verify at the official NPI Registry.