NPIMap

Organization Active NPI

Forefront Eyecare PLLC

  • Optometrist
  • Boston, MA
National Provider Identifier
1578713228
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2019 Issued in MA
Legal business name
FOREFRONT EYECARE PLLC
Practice address
99 Bedford Street
Suite 102
Boston, MA 02111
Phone
(617) 426-0370
Fax
(617) 426-4924
NPI assigned
Sep 30, 2008
Last updated
Dec 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Authorized official

Name
Mr. Michael Gulla
Title
Administrator
Phone
(617) 426-0370

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2019 MA Primary

Addresses

Primary practice location

99 Bedford Street
Suite 102
Boston, MA 02111

Mailing address

400 Commonwealth Avenue
Suite 2
Boston, MA 02215
Phone (617) 426-0370

Other identifiers 2

IdentifierTypeStateIssuer
0308714MedicaidMA
W20149OtherMABLUE CROSS AND BLUE SHIELD MA

Other names 1

  • Korb and Associates PLLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160624000309 MA Part B Supplier - Clinic/Group Practice 8123319043 Receives reassigned benefits from 9 practitioners
Practice locations: Boston, MA

National Provider Directory

National Provider Directory

Locations

400 Commonwealth Ave
Ste 2
Boston, MA 02215
Phone (617) 426-0370

99 Bedford St
Boston, MA 02111

99 Bedford St
Lbby 102
Boston, MA 02111
Phone (617) 426-0370

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733961600000",
    "number": "1578713228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 COMMONWEALTH AVENUE",
            "address_2": "SUITE 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02215",
            "telephone_number": "617-426-0370",
            "fax_number": "617-426-4924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 BEDFORD STREET",
            "address_2": "SUITE 102",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02111",
            "telephone_number": "617-426-0370",
            "fax_number": "617-426-4924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREFRONT EYECARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-30",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A",
        "authorized_official_last_name": "GULLA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "617-426-0370",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MA",
            "license": "2019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0308714",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIELD  MA",
            "identifier": "W20149",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Korb and Associates PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.