Individual provider Active NPI

Irwin M Nathanson, O.D.

  • Optometrist
  • Danvers, MA
National Provider Identifier
1710966338
Registry record updated Jun 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2336 Issued in MA
Practice address
85 Constitution LN
Ste 100C
Danvers, MA 01923-3630
Phone
(978) 774-5510
Fax
(978) 774-3521
NPI assigned
Jan 12, 2006
Last updated
Jun 1, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 1, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2336 MA Primary

Addresses

Primary practice location

85 Constitution LN
Ste 100C
Danvers, MA 01923-3630

Mailing address

85 Constitution LN
Ste 100C
Danvers, MA 01923-3630
Phone (978) 774-5510

Other identifiers 1

IdentifierTypeStateIssuer
0322369MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120321000154 MA Practitioner - Optometry 5698935120 Practice locations: Danvers, MA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

85 Constitution Lane
Suite 100C
Danvers, MA 01923-3630

85 Constitution LN
Suite 100C
Danvers, MA 01923-3630
Phone (978) 774-5510

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Eye Specialists Optometrist PastSince Apr 10, 1998 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464739200000",
    "number": "1710966338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 CONSTITUTION LN",
            "address_2": "STE 100C",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "019233630",
            "telephone_number": "978-774-5510",
            "fax_number": "978-774-3521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 CONSTITUTION LN",
            "address_2": "STE 100C",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "019233630",
            "telephone_number": "978-774-5510",
            "fax_number": "978-774-3521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NATHANSON",
        "first_name": "IRWIN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-12",
        "last_updated": "2016-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "2336",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0322369",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danvers, MA

Sources for this page

Verify at the official NPI Registry.