Organization Active NPI

Portsmouth Eye PLLC

  • Optometrist
  • Portsmouth, NH
National Provider Identifier
1679922579
Registry record updated Jun 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
NH0844 Issued in NH
Legal business name
PORTSMOUTH EYE PLLC
Practice address
38 Daniel St.
Portsmouth, NH 03801
Phone
(603) 436-4509
NPI assigned
Jun 10, 2016
Organization subpart
Yes
Parent organization
PORTSMOUTH EYE PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 10, 2016

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

Authorized official

Name
Corissa McKallagal, O.D.
Title
Owner/Member
Phone
(603) 436-4509

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X NH0844 NH Primary

Addresses

Primary practice location

38 Daniel St.
Portsmouth, NH 03801

Mailing address

38 Daniel St.
Portsmouth, NH 03801

Other names 1

  • the eye glass shop Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160623000346 NH Part B Supplier - Clinic/Group Practice 9638460579 Receives reassigned benefits from 1 practitioner
Practice locations: Portsmouth, NH

National Provider Directory

National Provider Directory
Part of
Portsmouth Eye PLLC

Locations

38 Daniel St
Portsmouth, NH 03801
Phone (603) 436-4509

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1465516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465516800000",
    "number": "1679922579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 DANIEL ST.",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "03801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 DANIEL ST.",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "03801",
            "telephone_number": "603-436-4509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTSMOUTH EYE PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PORTSMOUTH EYE PLLC",
        "enumeration_date": "2016-06-10",
        "last_updated": "2016-06-10",
        "status": "A",
        "authorized_official_last_name": "MCKALLAGAL",
        "authorized_official_first_name": "CORISSA",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "603-436-4509",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "NH",
            "license": "NH0844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "the eye glass shop",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portsmouth, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.