Individual provider Active NPI

Debra A. Buduo, O.D.

  • Optometrist
  • Brookline, MA
National Provider Identifier
1538360243
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
MA4064 Issued in MA
Practice address
1314 Beacon St
Brookline, MA 02446-3701
Phone
(617) 232-2096
Fax
(617) 731-1522
NPI assigned
May 30, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X MA4064 MA Primary

Addresses

Primary practice location

1314 Beacon St
Brookline, MA 02446-3701

Mailing address

1314 Beacon St
Brookline, MA 02446-3701
Phone (617) 232-2096

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20190620002119 MA Practitioner - Optometry 8123352473 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4064MAMDRegistered Dietitian
MA4064MAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Bass River Optical, Inc. Optometrist CurrentSince Jun 6, 2019 Accepting new patients

Locations

173 Rt 6A
Orleans, MA 02653
Phone (508) 240-0898

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1538360243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1314 BEACON ST",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024463701",
            "telephone_number": "617-232-2096",
            "fax_number": "617-731-1522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1314 BEACON ST",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024463701",
            "telephone_number": "617-232-2096",
            "fax_number": "617-731-1522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUDUO",
        "first_name": "DEBRA",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-30",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "MA4064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookline, MA

Sources for this page

Verify at the official NPI Registry.