Active NPI
Nicholas Ryan Mairose, LDO
- Optician
- Dry Ridge, KY
National Provider Identifier
1821815093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 110747
- Practice address
- 20 Ferguson Blvd
Dry Ridge, KY 41035-8699 - Phone
- (859) 824-0724
- Fax
- (859) 824-0734
- NPI assigned
- Sep 20, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 110747 | KY | Primary |
Addresses
Primary practice location
20 Ferguson Blvd
Dry Ridge, KY 41035-8699
Mailing address
20 Ferguson Blvd
Dry Ridge, KY 41035-8699
Phone (859) 824-0724
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 |
|---|---|---|---|
| 110747 | KY | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726790400000",
"number": "1821815093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 FERGUSON BLVD",
"city": "DRY RIDGE",
"state": "KY",
"postal_code": "410358699",
"telephone_number": "859-824-0724",
"fax_number": "859-824-0734"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 FERGUSON BLVD",
"city": "DRY RIDGE",
"state": "KY",
"postal_code": "410358699",
"telephone_number": "859-824-0724",
"fax_number": "859-824-0734"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAIROSE",
"first_name": "NICHOLAS",
"middle_name": "RYAN",
"credential": "LDO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-09-20",
"last_updated": "2024-09-20",
"certification_date": "2024-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "KY",
"license": "110747",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dry Ridge, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.