Active NPI
David Michael Imondi, O.D.
- Optometrist
- Newington, CT
National Provider Identifier
1790754901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 002297
- Practice address
- VA Medical Center
555 Willard Avenue
Newington, CT 06111 - Phone
- (860) 667-6742
- Fax
- (860) 667-6833
- NPI assigned
- Mar 17, 2006
- Last updated
- Mar 11, 2020
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 002297 | CT | Primary |
| Optometrist | 152W00000X | 02297 | CT |
Addresses
Primary practice location
VA Medical Center
555 Willard Avenue
Newington, CT 06111
Mailing address
57 Bourbon Street
South Windsor, CT 06074
Phone (860) 539-0584
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4118833 | Medicaid | CT |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02297 | CT | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trimble Vision Services, LLC | Optometrist | Past | Accepting new patients |
| Ste. Marie Opticians Inc | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Optician
- East Hartford, CT
- NPI 1730564881
-
- Optometrist
- West Hartford, CT
- NPI 1093841967
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583884800000",
"number": "1790754901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "57 BOURBON STREET",
"city": "SOUTH WINDSOR",
"state": "CT",
"postal_code": "06074",
"telephone_number": "860-539-0584",
"fax_number": "860-652-3291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "VA MEDICAL CENTER",
"address_2": "555 WILLARD AVENUE",
"city": "NEWINGTON",
"state": "CT",
"postal_code": "06111",
"telephone_number": "860-667-6742",
"fax_number": "860-667-6833"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMONDI",
"first_name": "DAVID",
"middle_name": "MICHAEL",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-17",
"last_updated": "2020-03-11",
"certification_date": "2020-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CT",
"license": "002297",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CT",
"license": "02297",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4118833",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newington, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.