Siri Boonsirisermsook, O.D.
Individual provider Active NPI Optometrist · Stoneham, MA
NPI 1740369537 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1740369537
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 4307 (MA)
- Practice address
- 75 Main St
Stoneham, MA 02180-3305 - Phone
- (781) 438-3372
- Fax
- (781) 438-3050
- NPI assigned
- Nov 3, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Redstone Eye Associates LLC
Practice addresses (Care Compare)
75 Main St
Stoneham, MA 02180-3305
Phone (781) 438-3372
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050302000602 | MA | Practitioner - Optometry | 1355394354 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4307 | MA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Redstone Eye Associates, LLC | Optometrist | Current |
Accepting new patients |
Locations
75 Main St
Stoneham, MA 02180
Phone (781) 438-2505
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4307 | MA | Yes |
Addresses
Primary practice location
75 Main St
Stoneham, MA 02180-3305
Mailing address
75 Main St
Stoneham, MA 02180-3305
Phone (781) 438-3372
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MA4307 | Other | MA | EYE MED VISION CARE |
| 7614498 | Other | MA | AETNA PROVIDER NUMBER |
| AA29247 | Other | MA | HARVARD PILGRIM |
| W16362 | Other | MA | BLUE CROSS BLUE SHIELD |
Other providers in Stoneham, MA
- Patrick Bolger
- Sudha Bolla
- Diane Marie Bonanni
- Bond Shoe & Foot LLC
- Denise Boodoo
- Jolene Elizabeth Borchelt
- Boston Health & Wellness, LLC
- Boston Prolotherapy & Orthopaedics, PLLC
- Bostonivf-Crmi Holding, LLC
- Keri Susan Bouthiller
All providers in Stoneham, MA · Optometrist in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.