Active NPI
Eric D Canedy, OPTICIAN
- Optician
- Newton, MA
National Provider Identifier
1780600536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 5612
- Practice address
- 25 Needham St
Newton, MA 02461-1615 - Phone
- (617) 964-6681
- Fax
- (617) 630-0141
- NPI assigned
- Jul 14, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Optician | 156FX1800X | 5612 | MA | Primary |
| Optician | 156FX1800X | 568 | NH |
Addresses
Primary practice location
25 Needham St
Newton, MA 02461-1615
Mailing address
25 Needham St
Newton, MA 02461-1615
Phone (617) 964-6681
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0317454 | Medicaid | MA | |
| 30750750 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 568 | NH | MD | Social Worker |
| 5612 | MA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780600536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 NEEDHAM ST",
"city": "NEWTON",
"state": "MA",
"postal_code": "024611615",
"telephone_number": "617-964-6681",
"fax_number": "617-630-0141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 NEEDHAM ST",
"city": "NEWTON",
"state": "MA",
"postal_code": "024611615",
"telephone_number": "617-964-6681",
"fax_number": "617-630-0141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANEDY",
"first_name": "ERIC",
"middle_name": "D",
"credential": "OPTICIAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "MA",
"license": "5612",
"primary": true
},
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NH",
"license": "568",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0317454",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30750750",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newton, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.