Individual provider Active NPI

Anne F Kiernan, OD

  • Optometrist
  • Pawtucket, RI
National Provider Identifier
1790177400
Registry record updated Mar 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ODTA00450 Issued in RI
Practice address
2 Dexter St
Pawtucket, RI 02860-2996
Phone
(401) 723-9540
NPI assigned
Mar 4, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X ODTA00450 RI Primary

Addresses

Primary practice location

2 Dexter St
Pawtucket, RI 02860-2996

Mailing address

2 Dexter St
Pawtucket, RI 02860-2996
Phone (401) 723-9540

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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
I20150617000783 RI Practitioner - Optometry 6709197775 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 1992
Medicare assignment
May accept Medicare assignment
Group practices
Rhode Island Optometrics LLCGroup PAC ID 5799026662, 8 clinicians

Practice addresses (Care Compare)

1400 Oaklawn Ave
Cranston, RI 02920-2643
Phone (401) 463-6696

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ODTA00450RIMDOptometrist

Organizations & group practices 1

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": "1425427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425427200000",
    "number": "1790177400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 DEXTER ST",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028602996",
            "telephone_number": "401-723-9540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 DEXTER ST",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028602996",
            "telephone_number": "401-723-9540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIERNAN",
        "first_name": "ANNE",
        "middle_name": "F",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-04",
        "last_updated": "2015-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "RI",
            "license": "ODTA00450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pawtucket, RI

Sources for this page

Verify at the official NPI Registry.