Jacqueline Rose Smith

Primary specialty

OptometristTaxonomy code 152W00000X

License

5620 Issued in MA

Practice address

289 Moody St
Waltham, MA 02453-5284

Phone

(781) 894-2127

NPI assigned

May 23, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Optometry

Education

New England College of Optometry, 2023

Medicare assignment

May accept Medicare assignment

Group practices

Ejc Eyecare LLCGroup PAC ID 6901952134, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Ejc Eyecare, LLC

  • Optometrist
  • Waltham, MA
  • NPI 1235368275
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1684800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1508558024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 SUNNYHILL RD",
            "city": "LUNENBURG",
            "state": "MA",
            "postal_code": "014621331",
            "telephone_number": "978-870-2770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "289 MOODY ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024535284",
            "telephone_number": "781-894-2127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JACQUELINE",
        "middle_name": "ROSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-23",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "5620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ann Smileyphippen, M.S.C.C.C.S.L.P.
• Allison Smith, PH.D.
• Allison Smith, M.A. CCC-SLP
• Ann Elizabeth Smith, M.S., CF-SLP
• Ashley Smith
• Jennifer L Smith, CRNA
• Julia Smith, MSW
• Michael William Gauvin Smith, MS, CCC-SLP
• Paula J Smith
• Robert James Smith, PH.D.

• Optometrist in Waltham, MA
• Providers in Waltham, MA by specialty
• Optometrist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.