Active NPI
Jim Dela Barerra
- Optician
- Bloomfield, NJ
National Provider Identifier
1609064583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- D3037
- Practice address
- 1083 Broad St
Bloomfield, NJ 07003-2918 - Phone
- (973) 338-1717
- Fax
- (973) 338-1717
- NPI assigned
- Oct 4, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Optician | 156FX1800X | D3037 | NJ | Primary |
Addresses
Primary practice location
1083 Broad St
Bloomfield, NJ 07003-2918
Mailing address
1083 Broad St
Bloomfield, NJ 07003-2918
Phone (973) 338-1717
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 |
|---|---|---|---|
| D3037 | NJ | MD | Optician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PD Optics Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Eyewear Supplier
- Bloomfield, NJ
- NPI 1710168513
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191456000000",
"number": "1609064583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1083 BROAD ST",
"city": "BLOOMFIELD",
"state": "NJ",
"postal_code": "070032918",
"telephone_number": "973-338-1717",
"fax_number": "973-338-1717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1083 BROAD ST",
"city": "BLOOMFIELD",
"state": "NJ",
"postal_code": "070032918",
"telephone_number": "973-338-1717",
"fax_number": "973-338-1717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELA BARERRA",
"first_name": "JIM",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-04",
"last_updated": "2007-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NJ",
"license": "D3037",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomfield, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 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.