Regan Marquis Prudhomme, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

002721 Issued in CT

Practice address

194 Buckland Hills Dr
Suite 1106
Manchester, CT 06042

Phone

(860) 644-3364

Fax

(860) 667-4377

NPI assigned

Jul 26, 2007

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

Other names 1

• Regan Sarah Marquis Former name

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
• Dr. Aucello & Associates, P.C.

  • Optometrist
  • Newington, CT
  • NPI 1912035056
  NPD (past)

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429747200000",
    "number": "1548450588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "194 BUCKLAND HILLS DR",
            "address_2": "SUITE 1106",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "06042",
            "telephone_number": "860-644-3364",
            "fax_number": "860-667-4377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "194 BUCKLAND HILLS DR",
            "address_2": "SUITE 1106",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "06042",
            "telephone_number": "860-644-3364",
            "fax_number": "860-667-4377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUDHOMME",
        "first_name": "REGAN",
        "middle_name": "MARQUIS",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-26",
        "last_updated": "2015-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "002721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REGAN",
            "last_name": "MARQUIS",
            "middle_name": "SARAH",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Prospect Manchester Hospital, Inc.
• Prospect Manchester Hospital, Inc.
• Heather A Prouty
• Jaclyn D Provencher
• Prudhomme Vision LLC
• Sheenay Kendra Pryce, MD
• Thomas James Ptachcinski, B.S.
• Ptsma Inc (Select Physical Therapy)
• Mimi Pugh, LADC
• Kenneth M Pulk

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2015; 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.