Active NPI
Kenneth Blum, OD
- Optometrist
- Stamford, CT
National Provider Identifier
1386741809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 961
- Practice address
- 100 Greyrock Place
Stamford Town Center
Stamford, CT 06901-3118 - Phone
- (203) 359-9600
- Fax
- (203) 975-8336
- NPI assigned
- Sep 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 961 | CT | Primary |
Addresses
Primary practice location
100 Greyrock Place
Stamford Town Center
Stamford, CT 06901-3118
Mailing address
100 Greyrock Place
Stamford Town Center
Stamford, CT 06901-3118
Phone (203) 359-9600
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386741809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 GREYROCK PLACE",
"address_2": "STAMFORD TOWN CENTER",
"city": "STAMFORD",
"state": "CT",
"postal_code": "069013118",
"telephone_number": "203-359-9600",
"fax_number": "203-975-8336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 GREYROCK PLACE",
"address_2": "STAMFORD TOWN CENTER",
"city": "STAMFORD",
"state": "CT",
"postal_code": "069013118",
"telephone_number": "203-359-9600",
"fax_number": "203-975-8336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLUM",
"first_name": "KENNETH",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CT",
"license": "961",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.