Individual provider Active NPI

Mark David Sturgis, O.D.

  • Optometrist
  • Manchester, CT
National Provider Identifier
1740226752
Registry record updated Dec 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2010 Issued in CT
Practice address
29 Buckland St
Manchester, CT 06042-1601
Phone
(860) 646-6655
Fax
(860) 647-7872
NPI assigned
Jun 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management Optometrist 152WC0802X 2010 CT
Occupational Vision Optometrist 152WX0102X 2010 CT
Optometrist 152W00000X 2010 CT Primary
Pediatric Optometrist 152WP0200X 2010 CT

Addresses

Primary practice location

29 Buckland St
Manchester, CT 06042-1601

Mailing address

1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20100927001014 CT Practitioner - Optometry 6305855776 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
002010CTMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Connecticut, LLC Optometrist CurrentSince Jan 25, 2021 Accepting new patients
Myeyedr Optometry of Connecticut, LLC Optometrist CurrentSince Jan 25, 2021 Accepting new patients
Myeyedr Optometry of Connecticut, LLC Optometrist Current Accepting new patients
New England Eyecare of Manchester, P.C. Optometrist Past Accepting new patients
New England Eyecare of Manchester, P.C. Optometrist Past Accepting new patients

Locations

145 Wakelee Ave
Ansonia, CT 06401
Phone (203) 734-1686

29 Buckland St
Manchester, CT 06042
Phone (860) 646-6655

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609200000000",
    "number": "1740226752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 BUCKLAND ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060421601",
            "telephone_number": "860-646-6655",
            "fax_number": "860-647-7872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STURGIS",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2020-12-29",
        "certification_date": "2020-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CT",
            "license": "2010",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": "CT",
            "license": "2010",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "2010",
            "primary": true
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "CT",
            "license": "2010",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

Verify at the official NPI Registry.