Individual provider Active NPI

Keith M Lemire, OD

  • Ophthalmology Physician
  • Waterford, CT
National Provider Identifier
1477511426
Registry record updated Oct 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
002391 Issued in CT
Practice address
741 Broad St Ext
Waterford, CT 06385
Phone
(860) 442-5663
Fax
(860) 444-7778
NPI assigned
May 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 002391 CT Primary

Addresses

Primary practice location

741 Broad St Ext
Waterford, CT 06385

Mailing address

741 Broad St Ext
Waterford, CT 06385
Phone (860) 442-5663

Other identifiers 1

IdentifierTypeStateIssuer
410045811OtherCTRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20111223000061 CT Practitioner - OptometryPractitioner - Ophthalmology 6800062787 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shoreline Eye Group PCGroup PAC ID 3971641002, 4 clinicians

Practice addresses (Care Compare)

741 Broad St Ext
Waterford, CT 06385-1347
Phone (860) 442-5663

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
002391CTMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Shoreline Eye Group PC Ophthalmology CurrentSince Oct 23, 2000 Accepting new patients

Locations

633 Middlesex Tpke
Ste 107
Old Saybrook, CT 06475
Phone (860) 388-4242

741 Broad Street Ext
Waterford, CT 06385
Phone (860) 442-5663

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": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288051200000",
    "number": "1477511426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "741 BROAD ST EXT",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "06385",
            "telephone_number": "860-442-5663",
            "fax_number": "860-444-7778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 BROAD ST EXT",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "06385",
            "telephone_number": "860-442-5663",
            "fax_number": "860-444-7778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEMIRE",
        "first_name": "KEITH",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2010-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CT",
            "license": "002391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "410045811",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, CT

Sources for this page

Verify at the official NPI Registry.