NPIMap

Organization Active NPI

Prudhomme Vision LLC

  • Optometrist
  • Manchester, CT
National Provider Identifier
1649504432
Registry record updated Mar 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
CT002725 Issued in CT
Legal business name
PRUDHOMME VISION LLC
Practice address
194 Buckland Hills Dr
Suite 1106
Manchester, CT 06042-8705
Phone
(860) 233-2668
NPI assigned
Sep 25, 2009
Last updated
Mar 14, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2016

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

Authorized official

Name
Dr. Jeremy Earl Prudhomme, O.D.NPI 1518151182
Title
Manager/Owner
Phone
(617) 448-9295

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X CT002725 CT Primary

Addresses

Primary practice location

194 Buckland Hills Dr
Suite 1106
Manchester, CT 06042-8705

Mailing address

12 Nottingham Blvd
Unionville, CT 06085-1185
Phone (617) 448-9295

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160311001107 CT Part B Supplier - Clinic/Group Practice 6709182041 Receives reassigned benefits from 7 practitioners
Practice locations: Farmington, CT; South Windsor, CT

National Provider Directory

National Provider Directory

Locations

61 Westfarms Mall
Ste D111
Farmington, CT 06032
Phone (860) 561-5687

194 Buckland Hills Dr
Ste 1106
Manchester, CT 06042
Phone (860) 233-2668

401 Evergreen Way
Unit 415
South Windsor, CT 06074
Phone (860) 644-3364

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": "1253836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457913600000",
    "number": "1649504432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 NOTTINGHAM BLVD",
            "city": "UNIONVILLE",
            "state": "CT",
            "postal_code": "060851185",
            "telephone_number": "617-448-9295"
        },
        {
            "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": "060428705",
            "telephone_number": "860-233-2668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRUDHOMME VISION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-25",
        "last_updated": "2016-03-14",
        "status": "A",
        "authorized_official_last_name": "PRUDHOMME",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "EARL",
        "authorized_official_title_or_position": "MANAGER/OWNER",
        "authorized_official_telephone_number": "617-448-9295",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "CT002725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2016; 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.