Dr. Bertolli OD & Associates LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

DR. BERTOLLI OD & ASSOCIATES LLC

Practice address

470 Lewis Avenue
C/O Sears Optical
Meriden, CT 06451

Phone

(203) 238-3080

Fax

(203) 238-0207

NPI assigned

Mar 24, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Eugene Robert Bertolli, OD

Title

Member

Phone

(203) 238-3080

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1269388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290556800000",
    "number": "1659695344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "470 LEWIS AVENUE",
            "address_2": "C/O SEARS OPTICAL",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "06451",
            "telephone_number": "203-238-3080",
            "fax_number": "203-238-0207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 LEWIS AVENUE",
            "address_2": "C/O SEARS OPTICAL",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "06451",
            "telephone_number": "203-238-3080",
            "fax_number": "203-238-0207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. BERTOLLI OD & ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-24",
        "last_updated": "2010-11-24",
        "status": "A",
        "authorized_official_last_name": "BERTOLLI",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "203-238-3080",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CT",
            "license": "2015",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Meriden, CT
• Providers in Meriden, CT by specialty
• Optometrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.