Kristen Jean Taddie, O.D.
Individual provider Active NPI Optometrist · N Syracuse, NY
NPI 1831483585 · NPPES record last updated Oct 31, 2016
Key facts
- NPI
- 1831483585
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- TUV007736 (NY)
- Practice address
- 125 Lawrence Rd E
N Syracuse, NY 13212-3844 - Phone
- (315) 455-5500
- NPI assigned
- May 29, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Moore Eye Care LLC
Practice addresses (Care Compare)
683 Broad St
Bristol, CT 06010-6694
Phone (860) 583-2020
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170919003423 | CT | Practitioner - Optometry | 9436305737 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TUV007736 | NY | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Moore Eye Care LLC | Optometrist | Current |
Accepting new patients |
Locations
683 Broad St
Bristol, CT 06010
Phone (860) 583-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TUV007736 | NY | Yes |
Addresses
Primary practice location
125 Lawrence Rd E
N Syracuse, NY 13212-3844
Mailing address
5100 W Taft Rd
Ste 4M
Liverpool, NY 13088-3810
Phone (315) 455-5500
Other providers in N Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.