Active NPI
Charles Robertson, DO
- Optometrist
- Medford, MA
National Provider Identifier
1841355054
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3368
- Practice address
- 26 City Hall Mall
Medford, MA 02155-4754 - Phone
- (781) 306-5184
- Fax
- (781) 306-5080
- NPI assigned
- Dec 27, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3368 | MA | Primary |
Addresses
Primary practice location
26 City Hall Mall
Medford, MA 02155-4754
Mailing address
147 Milk St
Boston, MA 02109-4806
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0312932 | Medicaid | MA | |
| 8278875-002 | Other | MA | CIGNA |
| W16027 | Other | MA | BCBS |
| 0014539 | Other | MA | NHP |
| 003368 | Other | MA | TUFTS |
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
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3368 | MA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307491200000",
"number": "1841355054",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "147 MILK ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021094806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 CITY HALL MALL",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021554754",
"telephone_number": "781-306-5184",
"fax_number": "781-306-5080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "CHARLES",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-27",
"last_updated": "2011-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MA",
"license": "3368",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0312932",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "8278875-002",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "W16027",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NHP",
"identifier": "0014539",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "003368",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.