Optometric Specialty Group of Simsbury PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

OPTOMETRIC SPECIALTY GROUP OF SIMSBURY PLLC

Practice address

883 Hopmeadow St
Simsbury, CT 06070-1884

Phone

(860) 658-1620

Fax

(860) 658-7923

NPI assigned

Jul 13, 2022

Organization subpart

No

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

Authorized official

Name

Peter Pegolo, ODNPI 1184733255

Title

OD/President

Phone

(860) 658-1620

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Peter Pegolo, OD

  • Optometrist
  • West Hartford, CT
  • NPI 1184733255
  Medicare reassignment NPD Authorized official
• Joseph Nicholas Petitti, O.D.

  • Optometrist
  • Simsbury, CT
  • NPI 1912099292
  Medicare reassignment NPD
• Amaria Victoria Sharon, OD

  • Optometrist
  • Newington, CT
  • NPI 1689355919
  Medicare reassignment NPD
• Korab Spahiu, OD

  • Optometrist
  • Waterbury, CT
  • NPI 1801313606
  Medicare reassignment NPD

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

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667260800000",
    "number": "1457085722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "883 HOPMEADOW ST",
            "city": "SIMSBURY",
            "state": "CT",
            "postal_code": "060701884",
            "telephone_number": "860-658-1620",
            "fax_number": "860-658-7923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "883 HOPMEADOW ST",
            "city": "SIMSBURY",
            "state": "CT",
            "postal_code": "060701884",
            "telephone_number": "860-658-1620",
            "fax_number": "860-658-7923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTOMETRIC SPECIALTY GROUP OF SIMSBURY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-13",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "status": "A",
        "authorized_official_last_name": "PEGOLO",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OD/PRESIDENT",
        "authorized_official_telephone_number": "860-658-1620",
        "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": []
}

• Keysa Janice Nieves, OTR/L
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• Nourished Life, LLC
• Kellee Marie O'Melia, OTR/L
• Fawn Sheryl Oldham, PT
• Stephen Lord Paine, L.AC., OMD
• Jill Elizabeth Palmer, LCSW
• Victoria Palmisano, LMT
• Ashley Pease, OTR/L
• Peoplesdental, P.C.

• Optometrist in Simsbury, CT
• Providers in Simsbury, CT by specialty
• Optometrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2022; 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.