Active NPI
Poulin Optometric Eyecare , PLLC
- Optometrist
- Camden, NY
National Provider Identifier
1477052223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 0003386
- Legal business name
- POULIN OPTOMETRIC EYECARE , PLLC
- Practice address
- 94 Main St
Camden, NY 13316-1320 - Phone
- (315) 245-2443
- Fax
- (315) 245-1060
- NPI assigned
- Feb 7, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Ronald H Poulin, OD
- Title
- Owner
- Phone
- (315) 245-2443
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 0003386 | NY | Primary |
Addresses
Primary practice location
94 Main St
Camden, NY 13316-1320
Mailing address
2471 State Route 69
Camden, NY 13316-3728
Phone (315) 245-3963
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180809005587 | NY | Part B Supplier - Clinic/Group Practice | 1557619392 |
Receives reassigned benefits from 6 practitioners Practice locations: Camden, NY; East Syracuse, NY |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 8
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Optometrist
- Utica, NY
- NPI 1609835685
-
- Optometrist
- Boonville, NY
- NPI 1952300824
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517961600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1649116800000",
"number": "1477052223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2471 STATE ROUTE 69",
"city": "CAMDEN",
"state": "NY",
"postal_code": "133163728",
"telephone_number": "315-245-3963",
"fax_number": "315-245-1060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "94 MAIN ST",
"city": "CAMDEN",
"state": "NY",
"postal_code": "133161320",
"telephone_number": "315-245-2443",
"fax_number": "315-245-1060"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "POULIN OPTOMETRIC EYECARE , PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-02-07",
"last_updated": "2022-04-05",
"certification_date": "2022-04-05",
"status": "A",
"authorized_official_last_name": "POULIN",
"authorized_official_first_name": "RONALD",
"authorized_official_middle_name": "H",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "315-245-2443",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "NY",
"license": "0003386",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camden, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 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.