Eye Doc LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

EYE DOC LLC

Practice address

371 Main St
Sturbridge, MA 01566-1665

Phone

(774) 241-0718

NPI assigned

Mar 4, 2021

Last updated

Mar 4, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Marie Mantelli, OD

Title

Owner

Phone

(860) 930-9947

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1614816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614816000000",
    "number": "1689269276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 MESSIER RD",
            "city": "NORTH GROSVENORDALE",
            "state": "CT",
            "postal_code": "062552012",
            "telephone_number": "860-930-9947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "371 MAIN ST",
            "city": "STURBRIDGE",
            "state": "MA",
            "postal_code": "015661665",
            "telephone_number": "774-241-0718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE DOC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-04",
        "last_updated": "2021-03-04",
        "certification_date": "2021-02-14",
        "status": "A",
        "authorized_official_last_name": "MANTELLI",
        "authorized_official_first_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-930-9947",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851845713",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gisele Marie Duplessis, MSW, LICSW
• Eastern Integrations, LLC (Acupuncture & Oriental Medicine of Sturbridge)
• Electra Health Medical Mass PC
• Elizabeth Prokos Berry
• David Michael Erani, M.D.
• Casey Fairbrother, PHARMD
• Junjie Fang, M.D.
• Ashraf Farid, MD
• Form First Physical Therapy LLC
• Cynthia E Fugere, LMFT, LMHC, M.ED

• Optometrist in Sturbridge, MA
• Providers in Sturbridge, MA by specialty
• Optometrist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; 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.