Jeremy Earl Prudhomme, O.D

Primary specialty

OptometristTaxonomy code 152W00000X

License

2725 Issued in CT

Practice address

495 Union St Ste 1082
Waterbury, CT 06706-1285

Phone

(203) 591-8353

NPI assigned

Aug 28, 2007

Sex

Male

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 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

Specialty

Optometry

Education

New England College of Optometry, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prudhomme Vision LLCGroup PAC ID 6709182041, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Prudhomme Vision LLC

  • Optometrist
  • Manchester, CT
  • NPI 1649504432
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1188259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188259200000",
    "number": "1518151182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 UNION ST STE 1082",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067061285",
            "telephone_number": "203-591-8353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 UNION ST STE 1082",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067061285",
            "telephone_number": "203-591-8353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUDHOMME",
        "first_name": "JEREMY",
        "middle_name": "EARL",
        "name_prefix": "Dr.",
        "credential": "O.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-28",
        "last_updated": "2007-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "2725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mari-Ann Pronovost, PT
• Giuseppe Miguel Proscino
• Prospect Family Dental, LLC
• Prospect Waterbury, Inc.
• Proxtalker.Com,LLC
• Joseph Mark Pruner, M.D.
• Christopher Prus, LPC
• Hector Rodolfo Pun, MD
• Michelle L Purcaro, MSN APRN
• Paige Elizabeth Purificato, RN

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2007; 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.