Individual provider Active NPI

Joseph Segal, O.D.

  • Optometrist
  • South Windsor, CT
National Provider Identifier
1780733436
Registry record updated Aug 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
708 Issued in CT
Practice address
1735 Ellington Rd
South Windsor, CT 06074-2719
Phone
(860) 644-2364
Fax
(860) 644-3920
NPI assigned
Jan 10, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 28, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 708 CT Primary

Addresses

Primary practice location

1735 Ellington Rd
South Windsor, CT 06074-2719

Mailing address

1735 Ellington Rd
South Windsor, CT 06074-2719
Phone (860) 644-2364

Other identifiers 1

IdentifierTypeStateIssuer
004023776MedicaidCT

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
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
708CTMDPhysician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219881600000",
    "number": "1780733436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1735 ELLINGTON RD",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060742719",
            "telephone_number": "860-644-2364",
            "fax_number": "860-644-3920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1735 ELLINGTON RD",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060742719",
            "telephone_number": "860-644-2364",
            "fax_number": "860-644-3920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEGAL",
        "first_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2008-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004023776",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Windsor, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.