Active NPI
Peter John Fedora, L.O.
- Optician
- Manchester, CT
National Provider Identifier
1659493021
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 000601
- Practice address
- 236 N Main St
Manchester, CT 06042-2004 - Phone
- (860) 646-3577
- Fax
- (860) 643-9733
- NPI assigned
- Apr 4, 2007
- 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 |
|---|---|---|---|---|
| Optician | 156FX1800X | 000601 | CT | Primary |
Addresses
Primary practice location
236 N Main St
Manchester, CT 06042-2004
Mailing address
25 White Rd
Tolland, CT 06084-2541
Phone (860) 646-3577
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06-1198912 | Other | CT | FEDERAL TAXPAYER ID |
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 |
|---|---|---|---|
| 000601 | CT | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1659493021",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 WHITE RD",
"city": "TOLLAND",
"state": "CT",
"postal_code": "060842541",
"telephone_number": "860-646-3577",
"fax_number": "860-643-9733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "236 N MAIN ST",
"city": "MANCHESTER",
"state": "CT",
"postal_code": "060422004",
"telephone_number": "860-646-3577",
"fax_number": "860-643-9733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEDORA",
"first_name": "PETER",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"credential": "L.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "CT",
"license": "000601",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL TAXPAYER ID",
"identifier": "06-1198912",
"state": "CT"
}
],
"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 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.