Active NPI
Lisa Fanciullo, O.D.
- Optometrist
- West Roxbury, MA
National Provider Identifier
1700998671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3692
- Practice address
- 1400 VFW Pkwy
West Roxbury, MA 02132-4927 - Phone
- (617) 323-7700
- Fax
- (857) 203-5706
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4532 T1262 | OH | |
| Optometrist | 152W00000X | 3692 | MA | Primary |
Addresses
Primary practice location
1400 VFW Pkwy
West Roxbury, MA 02132-4927
Mailing address
1400 VFW Pkwy
West Roxbury, MA 02132-4927
Phone (617) 323-7700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3692 | MA | MD | Optometrist |
| 4532 T1262 | OH | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1700998671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 VFW PKWY",
"city": "WEST ROXBURY",
"state": "MA",
"postal_code": "021324927",
"telephone_number": "617-323-7700",
"fax_number": "857-203-5706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 VFW PKWY",
"city": "WEST ROXBURY",
"state": "MA",
"postal_code": "021324927",
"telephone_number": "617-323-7700",
"fax_number": "857-203-5706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANCIULLO",
"first_name": "LISA",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OH",
"license": "4532 T1262",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MA",
"license": "3692",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Roxbury, MA
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.