Individual provider Active NPI

Crystal Marie Lewandowski

  • Optometrist
  • Wellesley, MA
National Provider Identifier
1740621069
Registry record updated Jul 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4970 Issued in MA
Practice address
1 Washington St
Wellesley, MA 02481-1711
Phone
(617) 332-1471
NPI assigned
Jul 15, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 15, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4970 MA Primary

Addresses

Primary practice location

1 Washington St
Wellesley, MA 02481-1711

Mailing address

426 Marlborough St Apt 5
Boston, MA 02115-1222
Phone (716) 783-4778

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
I20131107000576 MA Practitioner - Optometry 4789819350 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2013
Medicare assignment
May accept Medicare assignment
Group practices
North End Community Health Committee, Inc.Group PAC ID 8224043971, 56 clinicians

Practice addresses (Care Compare)

332 Hanover St
Boston, MA 02113-1901
Phone (617) 643-8000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4970MAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
South Boston Community Health Center CurrentSince Jan 1, 2020 Accepting new patients

Locations

409 W Broadway
South Boston, MA 02127
Phone (617) 269-7500

Organizations & group practices 2

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": "1373846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373846400000",
    "number": "1740621069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "426 MARLBOROUGH ST APT 5",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021151222",
            "telephone_number": "716-783-4778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WASHINGTON ST",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024811711",
            "telephone_number": "617-332-1471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWANDOWSKI",
        "first_name": "CRYSTAL",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-07-15",
        "last_updated": "2013-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wellesley, MA

Sources for this page

Verify at the official NPI Registry.