Active NPI
Michael C Wellington, OD
- Optometrist
- Pittsfield, MA
National Provider Identifier
1558478768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2407
- Practice address
- 555 Hubbard Ave
Pittsfield, MA 01201-3876 - Phone
- (413) 442-2848
- NPI assigned
- Aug 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2407 | MA | Primary |
Addresses
Primary practice location
555 Hubbard Ave
Pittsfield, MA 01201-3876
Mailing address
22 Temple St
Adams, MA 01220-2105
Phone (413) 743-4979
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0320676 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2407 | MA | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1558478768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 TEMPLE ST",
"city": "ADAMS",
"state": "MA",
"postal_code": "012202105",
"telephone_number": "413-743-4979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 HUBBARD AVE",
"city": "PITTSFIELD",
"state": "MA",
"postal_code": "012013876",
"telephone_number": "413-442-2848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELLINGTON",
"first_name": "MICHAEL",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MA",
"license": "2407",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0320676",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pittsfield, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.